{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:40:22Z","timestamp":1788514822953,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> This study aims to evaluate outcome after conservative management (no pharmacological\/surgical intervention other than fluid restriction, diuretics, or ventilator adjustments) compared with active (pharmacological and\/or surgical) treatment for patent ductus arteriosus (PDA) in preterm infants and analyze differences in outcome between randomized controlled trials (RCTs) and cohort studies.<\/jats:p><jats:p><jats:bold>Study Design:<\/jats:bold> This is a systematic literature review using PubMed, EMBASE, and Cochrane library. RCTs and cohort studies comparing conservative management with active treatment were included. Meta-analysis was used to compare conservative management with any active (pharmacological and\/or surgical), any pharmacological (non-prophylactic and prophylactic), and\/or surgical treatment for mortality as primary and major neonatal morbidity as secondary outcome measure. Fixed-effect analysis was used, unless heterogeneity (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>) was &amp;gt;50%. Outcome is presented as relative risk (RR) with 95% confidence interval.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Twelve cohort studies and four RCTs were included, encompassing 41,804 and 720 patients, respectively. In cohort studies, conservative management for PDA was associated with a significantly higher risk for mortality (RR, 1.34 [1.12\u20131.62]) but a significantly lower risk for bronchopulmonary dysplasia (RR, 0.55 [0.46\u20130.65]), necrotizing enterocolitis (RR, 0.85 [0.77\u20130.93]), intraventricular hemorrhage (RR, 0.88 [0.83\u20130.95]), and retinopathy of prematurity (RR, 0.47 [0.28\u20130.79]) compared with any active PDA treatment. Meta-analysis of the RCTs revealed no significant differences in outcome between conservative management and active treatment.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> No differences in mortality or morbidity for conservative management compared with active treatment regimens were observed in RCTs. Findings from cohort studies mainly highlight the lack of high-quality evidence for conservative management for PDA in preterm infants.<\/jats:p>","DOI":"10.3389\/fped.2021.626261","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T05:16:41Z","timestamp":1614230201000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":36,"title":["Conservative Management of Patent Ductus Arteriosus in Preterm Infants\u2014A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies"],"prefix":"10.3389","volume":"9","author":[{"given":"Tim","family":"Hundscheid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther J. 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