Patent Ductus Arteriosus Management in Very Preterm Infants: Center-Level Treatment Strategies and Outcomes Across the Neocosur Network

Objective To assess whether center-level variation in patent ductus arteriosus (PDA) treatment intensity is associated with bronchopulmonary dysplasia (BPD) or death in very preterm infants. Study Design Retrospective multicenter cohort study using prospectively collected data from the Neocosur Neonatal Network (2015–2021). Infants born at ≤ 28 weeks’ gestation with PDA were included. Centers were classified into quartiles according to PDA treatment rate. The primary outcome was BPD or death. Mixed-effects logistic regression models with a random intercept for center were fitted and adjusted for gestational age. Results The cohort included 2,777 infants from 32 NICUs. PDA treatment rates varied widely across centers. After accounting for center-level clustering, treatment attitude was not associated with BPD or death. Gestational age showed a strong inverse association with the outcome. Approximately 8% of outcome variability was attributable to between-center differences. Conclusions Center-level PDA treatment intensity was not associated with major outcomes, supporting individualized, physiology-informed management.