To assess patent ductus arteriosus (PDA) treatment variation between Swiss perinatal centers and to determine its effect on outcome in a population-based setting.
Retrospective cohort study of infants born below 28 weeks of gestation between 2012-2017. Outcomes between surgically ligated and pharmacologically treated infants as well as infants born in centers performing ≤ 10% ligation (“low” group) and >10% (“high” group) were compared using logistic regression and 1:1 propensity score matching. Matching was based on case-mix and pre-ligation confounders: intraventricular hemorrhages grades 3-4, necrotizing enterocolitis, sepsis, and ≥28 days oxygen supply.
Of 1389 infants, 722 (52%) had pharmacological treatment and 156 (11·2%) received surgical ligation. Compared to infants receiving pharmacological treatment, ligated infants had higher odds for major morbidities (OR 2·09, 95% CI 1·44 – 3·04) and 2-year neurodevelopmental impairment (OR 1·81, 95% CI 1·15 – 2·84). Mortality was comparable after restricting the cohort to infants surviving at least until day 10 to avoid survival bias. In the “low” group, 34 (4·9%) of 696 infants were ligated compared to 122 (17·6%) of 693 infants in the “high” group. Infants in the “high” group had higher odds for major morbidities (OR 1·49, 95% CI 1·11 – 2·0).
Our analysis identified a burden on infants receiving surgical ligation versus pharmacological treatment in a population-based setting where there was no agreed upon common procedure. These results may guide a revision of PDA treatment practice in Switzerland.

Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.