| Title: |
Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants |
| Authors: |
Laughon, Matthew M.; Thomas, Sonia M.; Watterberg, Kristi L.; Kennedy, Kathleen A.; Keszler, Martin; Ambalavanan, Namisavayam; Davis, Alexis S.; Slaughter, Jonathan L.; Guillet, Ronnie; Colaizy, Tarah T.; Cotten, C. Michael; Dhawan, Megan A.; Bose, Carl L.; Talbert, Jennifer; Smucny, Sarah; Benitz, William E.; Rysavy, Matthew A.; Ohls, Robin K.; Baserga, Mariana C.; DeMauro, Sara B.; Jaleel, Mambarambath; Jackson, Wesley M.; Carlo, Waldemar A.; Puopolo, Karen M.; Hibbs, Anna Maria; Katheria, Anup; Sánchez, Pablo J.; D’Angio, Carl T.; Patel, Ravi M.; Johnson, Beth Ann; Chock, Valerie Y.; Bhatt, Abhay J.; Merhar, Stephanie L.; Moore, Ryan; Laptook, Abbot R.; Ghavam, Sarvin; Fuller, Janell; Vyas-Read, Shilpa; Kicklighter, Stephen D.; Steinbrekera, Baiba; Anderson, Kathryn; Reynolds, Anne Marie; Wyckoff, Myra H.; Montoya, Cassandra; Das, Abhik; Do, Barbara; Chang, Samantha; Higgins, Rosemary D.; Walsh, Michele C.; Weiner, Steven J.; Hensman, Angelita M.; Porras, Kim; St. Pierre, Lucille; Vieira, Elisa; Henry, Rachael; Aaron Hamvas, Aaron Hamvas; deRegnier, Raye-Ann; Robinson, Daniel T.; Ward, Steven M.; Siner, Bonnie S.; Newman, Nancy S.; Wilson-Costello, Deanne E.; Beiersdorfer, Traci; Graber-Pels, Amy; Grisby, Cathy; Hess, Megan; Kim, Jae; King, Carla; Kirker, Kristin; Kramer, Haley; McKeown, Katherine; Muthig, Greg; Radcliff, Lisa; Reid, Cynthia; Russell, David; Schibler, Kurt; Thompson, Julia; D’Alton, Mary E.; Polin, Richard A.; Fisher, Kimberley A.; Goldberg, Ronald N.; Aleem, Samia; Babilonia-Rosa, Melissa; Bear, Kelly; Bergstedt, Vickie; Clark, Cindy; Finkle, Joanne; Makhijani, Sneha; Moseley, Sherry; Stone, Caitlin; Carlton, David P; Bottcher, Diane; Connor, Shelly; Laursen, Judith; Loggins, Yvonne; Mackie, Colleen; Thompson, Jayontra; Willinger, Marian; Bremer, Andrew A; Higgins, Rosemary D; Archer, Stephanie Wilson; Allen, Marilee C.; Dominguez, Gabriela; Khan, Amir M.; Pucio, Ronald; Stephens, Emily; Wade, Jaleesa; Batterson, Nancy; Baugher, Hallie; Beckford, Demi R.; Benninger, Kristen; Boyle, Cara; Cobe, Chelsea; Cotterman, Riley; DeSantis, Brittany; Dixit, Himangini Singh; Glaze, Michael; Hanlon, Cory; Knox, Jordan; Kumar, Rachna; Luzader, Patricia; Mark, Eduardo Finol; Marzec, Laura; McCool, Jacqueline; McGovern, Kevin; Mendez, Gabriella; Miller, Bethany; Naik, Tanvi; Nelin, Mary Ann; Pennington, Theresa; Randle, Joanie; Resetar, Megan; Schiering, Jessica; Schmidt, Kelly; Shepherd, Stephanie; Small, Kristi; Stein, Melanie; Sullivan, Rox Ann; Talliker, Aishwarya; Tice, Abbie M.; Warnimont, Kyrstin; Zettler, Eli; Pickett, James W; Zaterka-Baxter, Kristin M; Auman, Jeanette O’Donnell; Lewis, Amanda; Mazur, Anna; Aliyev, Gabi; Arnell, Kathy; Dorner, Rebecca; Ines, Felix; Koo, Jenny; Peirson, April; Peterson, Catherine; Sauberan, Jason; Ball, M Bethany; Chuck, Jennifer E; Davis, Alexis S; Morris, Karen K; Recine, Barbara P; Van Meurs, Krisa P; Green, Gabrielle; Rutkowska, Lilia; Clemons, Traci; Benz, Rachel L; Buie, Cindie L; Foshee, Kathryn M; Gentle, Samuel; Owen, Sharon E; Salas, Ariel A; Shukla, Vivek S; Travers, Colm P; Turner, Sandra M; Cosby, Shirley S; McNair, Tara E; Steinhorn, Robin; Broadbent, Megan; Elenkiwich, Chelsey; Bell, Edward F; Goeke, Claire A; Henning, Megan M; Hogden, Laurie A; Johnson, Karen J; McNamara, Patrick J; Schmelzel, Mendi L; Walker, Jacky R; Van Muyden, Sarah; Giachelli, Chelsea A; Taylor, Nathan J; Famuyide, Mobolaji; Hodges, Sara; Jackson, Samantha; McKenzie, Christopher; Salazar, Nicole J; Beauman, Sandra Sundquist; Kuan, Elizabeth; Montoya, Jennifer; Dhawan, Megan A; Eichenwald, Eric C; Booth, Lauren; Catts, Christine; Crisafulli, Melanie; Gambacorta, Mary Catherine; Mancini, Toni; Snyder, Jonathan; Zola, Kimberly; Wadkins, Holly I M; Binion, Kyle; Bowman, Melissa; Boylin, Elizabeth; Donato, Jennifer; Jensen, Rosemary; Jones, Rachel; Kent, Alison; Li, Emily; Mckee, Kimberly; Moreland, Melissa; Sabaratnam, Premini; Scorsone, Ann Marie; Voelker, Kelsey; Brion, Luc; Chavez, Arpineh; Duran, Joanne; Kapadia, Vishal S.; Kawamura, Melissa; Lemler, Matthew; Roblyer, Lindsay; Sepulveda, Pollieanna; Webbon, Michelle Harrod; Coleman, Kathleen; Davis, Brandy; Bahr, Timothy M; Baserga, Mariana; Bell, Lisa M; Elmont, Jennifer O; Gerday, Erick B; Johnson, Susan E; Loertscher, Manndi C; Magana, Diana K; Marchant, Trisha; McGrath, Kandace M; Mickelsen, Hena G; Minton, Stephen D; Parry, D Melody; Petersen, Brandy J; Sheffield, Mark J; Woodbury, Kathryn D; Bentley, Dawn; Bledsoe, Laura Cole; Christensen, Susan; Fisher, Rachyl; Floyd, Luaiva; Moody, Susie Solosth; Pierce, Rebecka; Reich, Brixen A; Scullin, Blake; Weaver-Lewis, Kimberlee; Yoder, Bradley A; Boyle, Robert J.; Gleason, Christine A. |
| Source: |
JAMA, 335(7) |
| Publisher Information: |
American Medical Association (AMA) |
| Publication Year: |
2026 |
| Collection: |
Carolina Digital Repository (UNC - University of North Carolina) |
| Subject Terms: |
Research Network; gestation; screening; sets; management group; patent; dysplasia; hours; participants; postmenstrual age; ductus arteriosus; group; National Institute; preterm infants; medication; active treatment; Neonatal Research Network; death; treatment groups; National; network; active treatment group; components; weeks; interim analysis; Institute of Child Health; Human Development Neonatal Research Network; conclusions; prematurity; incidence of death |
| Description: |
Importance: The management of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To determine whether expectant management compared with active treatment of a protocol-defined PDA in preterm infants decreases the incidence of death or bronchopulmonary dysplasia (BPD). Design, Setting, and Participants: A randomized clinical trial including infants born at 22 to 28 weeks' gestation and diagnosed with a protocol-defined PDA between the age of 48 hours and 21 days at screening. The trial was conducted from December 2018 to December 2024 at 33 hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. The final date of follow-up was June 2025. Interventions: Infants with PDA were randomized to expectant management (n = 242) or active treatment (n = 240; acetaminophen, ibuprofen, or indomethacin) to close the PDA. Main Outcomes and Measures: The primary outcome was death or BPD at 36 weeks' postmenstrual age. The secondary outcomes included the components of the primary outcome and other morbidities of prematurity. Results: A total of 482 infants were randomized (median gestational age, 25 weeks [IQR, 24 to 27 weeks]; median birth weight, 760 g [IQR, 620 to 935 g]). The trial was stopped for futility and safety after the 50% interim analysis for the primary outcome due to higher survival in the expectant management group. The incidence of death or BPD was 80.9% (195/241) of infants in the expectant management group vs 79.6% (191/240) of infants in the active treatment group (adjusted risk difference, 1.2% [95% CI, -5.7% to 8.1%]; P = .73). The incidence of death before 36 weeks' postmenstrual age was 4.1% (10/241) of infants in the expectant management group vs 9.6% (23/240) of infants in the active treatment group (adjusted risk difference, -5.6% [95% CI, -10.1% to -1.2%]; P = .01). Infections resulting in death occurred in 0.8% (2/241) of infants in the expectant management group vs 3.8% (9/240) of infants in the active treatment group. ... |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
https://cdr.lib.unc.edu/downloads/qz20t822p?file=thumbnail; https://cdr.lib.unc.edu/downloads/qz20t822p |
| DOI: |
10.17615/nagw-9e25 |
| Availability: |
https://doi.org/10.17615/nagw-9e25; https://cdr.lib.unc.edu/downloads/qz20t822p?file=thumbnail; https://cdr.lib.unc.edu/downloads/qz20t822p |
| Rights: |
http://rightsstatements.org/vocab/InC/1.0/ |
| Accession Number: |
edsbas.81BB4ED0 |
| Database: |
BASE |