{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:11:07Z","timestamp":1785222667319,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> Although symptomatic treatment is the most preferred treatment strategy for proven symptomatic patent ductus arteriosus (PDA), a considerable number of infants only received conservative treatment without any pharmacological or surgical interventions in the lower gestational age and lower birth weight group in Korea. We compared in-hospital outcomes of infants treated conservatively without any intervention and those of infants managed by other therapeutic strategies in extremely preterm infants with symptomatic PDA.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A prospectively collected cohort study for 2,303 infants with gestational ages &amp;lt;28 weeks from the Korean Neonatal Network database. These infants were classified into four groups according to the presence of PDA-related symptoms and therapeutic treatment strategy: prophylactic treatment group, pre-symptomatic treatment (PST) group, symptomatic treatment (ST) group, and conservative treatment (CT) without any intervention group.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In multivariable logistic regression analysis, the risk of death was significantly decreased in the PST group (adjusted odds ratio [aOR] = 0.507; 95% confidence interval [CI] 0.311\u20130.826) and ST group (aOR = 0.349; 95% CI: 0.230\u20130.529) compared with the CT group. However, the risk of composite outcome of severe bronchopulmonary dysplasia or death had not increased in the PST group and ST group. Neonatal death due to pulmonary hemorrhage or neurological disease was significantly higher in the CT group than in the PST group or ST group.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> In extremely preterm infants, who are at highest risk of PDA-related morbidities and mortality, even less interventional approach for PDA can be allowed; the rescued pharmacological or surgical interventions are necessary if they met the criteria for hemodynamically significant PDA.<\/jats:p>","DOI":"10.3389\/fped.2021.729329","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T07:32:43Z","timestamp":1633591963000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Conservative Treatment Without Any Intervention Compared With Other Therapeutic Strategies for Symptomatic Patent Ductus Arteriosus in Extremely Preterm Infants: A Nationwide Cohort Study in Korea"],"prefix":"10.3389","volume":"9","author":[{"given":"Jeonghee","family":"Shin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin A","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohee","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Hee","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Min","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"CD003481","DOI":"10.1002\/14651858.CD003481.pub6","article-title":"Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants","volume":"2","author":"Ohlsson","year":"2015","journal-title":"Cochrane Database Syst Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"67","DOI":"10.4103\/2249-4847.134670","article-title":"Patent ductus arteriosus ligation and adverse outcomes: causality or bias?","volume":"3","author":"Weisz","year":"2014","journal-title":"J Clin Neonatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e20153730","DOI":"10.1542\/peds.2015-3730","article-title":"Patent ductus arteriosus in preterm infants","volume":"137","author":"Benitz","year":"2016","journal-title":"Pediatrics."},{"key":"B4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1002\/bdra.23235","article-title":"Epidemiology of bronchopulmonary dysplasia","volume":"100","author":"Jensen","year":"2014","journal-title":"Birth Defects Res A Clin Mol Teratol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.jpeds.2011.12.031","article-title":"Timing of patent ductus arteriosus treatment and respiratory outcome in premature infants: a double-blind randomized controlled trial","volume":"160","author":"Sosenko","year":"2012","journal-title":"J Pediatr."},{"key":"B6","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1055\/s-0039-1697674","article-title":"Neurodevelopmental impairment at two years in premature infants with prolonged patency of ductus arteriosus after a conservative approach","volume":"38","author":"Aldecoa-Bilbao","year":"2021","journal-title":"Am J Perinatol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1055\/s-0036-1586112","article-title":"Patent ductus arteriosus and short- and long-term respiratory outcomes","volume":"33","author":"Bancalari","year":"2016","journal-title":"Am J Perinatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e20170566","DOI":"10.1542\/peds.2017-0566","article-title":"Hey, Doctor, Leave the PDA alone","volume":"140","author":"Benitz","year":"2017","journal-title":"Pediatrics."},{"key":"B9","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1097\/00008480-200404000-00005","article-title":"Patency of the ductus arteriosus in the premature infant: is it pathologic? 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