- Posted December 15, 2025
Doing Nothing Appears Best Approach To Common Heart Defect Among Preemies
Doing nothing at all to manage a common fetal heart defect might improve the survival odds of babies born prematurely, compared to treatment with drugs, a new clinical trial suggests.
A “wait and see” approach to patent ductus arteriosus (PDA) doubled a preemie’s chances of survival, compared with using drugs to treat the condition, researchers reported Dec. 9 in the Journal of the American Medical Association.
“This trial showed no benefit of active treatment of the PDA in extremely preterm infants,” said lead researcher Dr. Matthew Laughon, a neonatologist at the University of North Carolina School of Medicine in Chapel Hill.
“In fact, it identified a higher chance of survival for (wait-and-see) expectant management, consistent with emerging data on the effects of early (i.e., prior to one or two weeks after birth) pharmacologic PDA treatment,” he said in a news release.
PDA occurs when a small blood vessel in the heart remains open after birth, researchers said in background notes.
The defect places stress on the heart and the lungs, as they have to work harder to deliver blood throughout the body. Researchers compared it to drinking through a straw that has a hole in it.
Every baby is born with this opening, according to the American Heart Association. It typically closes in most full-term infants soon after birth, but closure is often delayed among preemies and might not occur until after they’ve left the hospital, researchers said.
Treatment of PDA remains controversial among doctors, with no clear consensus on guidelines indicating the best approach, researchers said.
“There is wide variation in treatment of PDA in preterm infants,” Laughon said. “Some clinicians always treat, and some clinicians never treat. We need to know which one is better for babies.”
For the study, researchers enrolled 482 extremely pre-term infants with PDAs. All the babies were born between 22 and 28 weeks of gestation.
The preemies were randomly assigned to one of two groups — those who were managed with a wait-and-see approach, and those who received drugs like acetaminophen, indomethacin or ibuprofen to try to close the open blood vessel.
Results showed that about 4% of infants treated with the “wait and see” died within 36 weeks of postmenstrual age, which is the sum of a baby’s length of gestation and their post-delivery age. That compared with nearly 10% among those treated with drugs.
The medications used to treat PDA come with side effects that can affect a baby’s survival odds, researchers said. They can alter the immune system, reduce blood flow to the intestine, or cause injury to the mucous membranes of the GI system, leading to serious conditions like sepsis or death of intestinal tissue.
These results should be used to inform treatment strategies on PDA, potentially saving more lives, researchers concluded.
More information
The American Heart Association has more on patent ductus arteriosus.
SOURCE: University of North Carolina School of Medicine, news release, Dec. 10, 2025
