For a study, researchers sought to determine if treating patients with a presymptomatic patent ductus arteriosus (PDA) based on early routine echocardiogram, independent of clinical symptoms, improved outcomes. The multicenter, survey-linked retrospective cohort analysis included children born in 2014-2016 and admitted to tertiary neonatal intensive care units (NICUs) of nine population-based national or regional neonatal networks. Infants in NICUs who received presymptomatic PDA therapy were compared to those who did not for the key composite outcome (early death [≤7 days after delivery] or severe intraventricular hemorrhage) and secondary outcomes (any in-hospital mortality & major morbidities). The unit survey (86% response rate) demonstrated a substantial variance in presymptomatic PDA therapy among networks (7%-86%). About 126 NICUs (51%) with 7,785 newborns treated with presymptomatic PDA among 246 NICUs with 17,936 infants (mean gestational age of 26 weeks). The main result of early mortality or severe intraventricular hemorrhage did not differ substantially between NICUs that treated presymptomatic PDA and those that did not (17% vs 21%; aOR 1.00, 95% CI 0.85-1.18). The probabilities of retinopathy of prematurity therapy were higher in NICUs treating presymptomatic PDA (13% vs 7%; aOR 1.47, 95% CI 1.01-2.12); however, it was not significant in a sensitivity analysis removing data. Presymptomatic PDA diagnosed by regular echocardiography was routinely treated, although there were no notable advantages. To examine the efficacy and safety of early targeted PDA therapy, well-designed studies were required.