Abstract 4363963: Practice Variations in the Management of Hemodynamically Significant Patent Ductus Arteriosus in Neonates (hsPDA): A Survey of Neonatologists and Pediatric Cardiologists

Background: Management of hsPDA in neonates remains controversial, with substantial variation in clinical practice among neonatologists&cardiologists. Definition of hsPDA is based on clinical (status of respiratory, renal, GI function, BP's&murmur) and echo findings (PDA size, diastolic runoff, LA/LV size). Pharmacological, interventional, and surgical approaches are in use, but no consensus has emerged. This study aims to assess differences in decision-making, treatment strategies, and criteria used for treatment by different providers for hsPDA. Methods: A cross-sectional survey on timing, indications for screening, diagnostic modalities, various treatment approaches, factors influencing clinical decision-making, benefits, and risks of different treatment modalities for hsPDA was distributed to neonatologists and pediatric cardiologists. Chi-square test was used to evaluate associations between specialty and survey responses; with a significant p-value of <0.05. Results: Of 5000 surveyed, 491 responded and 462 completed surveys were analyzed (37% cardiologists, 63% neonatologists). Most providers start to screen for PDA based on clinical condition. 43% providers chose acetaminophen, 35% ibuprofen for initial treatment, and if initial management fail; 81% would treat again medically and only 12% chose to refer for invasive closure. 69% of providers (90% cardiologists; 60% neonatologists) stated that treatment of PDA decreases the risk of prematurity associated complications p<0.0001. Most providers believe that medical and catheter closure of hsPDA do not cause long term damage to brain, kidneys, or lungs, but a statistically significant difference is seen for surgical closure (p<0.0001) (Table 1). 76% of cardiologists and 27% of neonatologists believe that hsPDA closure decreases overall Morbidity and Mortality (MnM) (Figure 1A/1B (p=0.004)). In subgroup analysis, 90% of cardiologists believe PDA closure decreases PDA related complications, compared to 60% of neonatologists. 64% of neonatologists chose to treat hsPDA compared to 74% of cardiologists and 65% of neonatologists would not treat a hsPDA based on echo findings alone without clinical symptoms. Conclusion: Substantial variability exists in management, timing of screening, and management of failed treatment of hsPDA among groups of experts. Majority of providers feel that hsPDA closure decreases long term MnM. Future Direction: Standardized protocol may help reduce practice heterogeneity