Conservative management of patent ductus arteriosus in preterm infants: A systematic review and meta-analysis of randomized controlled trials

Background: In recent years, there has been a rise in the adoption of conservative approaches to managing patent ductus arteriosus (PDA) in preterm infants. Systematic appraisal of the clinical evidence supporting this approach is essential for guiding guideline recommendations. Aim of review: This systematic review and meta-analysis aims to investigate a strategy of conservative management in comparison to active treatment in preterm infants with PDA. Key scientific concepts of review: From inception to April 2024, we conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs) that evaluated conservative management versus active treatment of PDA in preterm infants. We used RevMan 5.4 to pool risk ratios (RRs). Our review included 6 RCTs. There was no difference in the risk of mortality (RR 0.83; 95 % CI: 0.64-1.08) and BPD (RR 0.89; 95 % CI: 0.76-1.03) between the conservative management and active treatment groups. The rates of necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, pulmonary hemorrhage, and the need for surgical ligation or transcatheter occlusion were similar between the two groups. In conclusion, our analysis showed no difference in the risk of all-cause mortality, BPD, or other clinical outcomes between a strategy of conservative management compared to active treatment. Further, large-scale RCTs focusing on targeted therapy for infants at the highest risk of complications from PDA are required.