Patent ductus arteriosus (PDA) treatment is common among very low birth weight (VLBW) infants. Given limitations in evidence, controversy exists regarding treatment risks and benefits. In this study, we describe PDA treatment trends and variation in a large, US, multicenter VLBW infant cohort.

Data were collected through Vermont Oxford Network on 291 292 VLBW infants born 2012–2019 at 806 US NICUs. PDA diagnosis and treatment rates, further categorized as pharmacologic, invasive, or combined, were determined. NICUs were classified as capable versus noncapable of invasive PDA treatment. Infant and hospital characteristics were examined by NICU type and treatment quartile. Geographic NICU distribution and treatment rates were described in 9 US census divisions.

Of all infants, 24.6% were diagnosed with and 20.5% were treated for PDA. Diagnosis and treatment rates decreased over the study period. Treatment was predominantly pharmacologic. Treatment rates varied widely among NICUs (0% to 67%) despite similar infant characteristics. The median treatment rate was higher at NICUs capable of pharmacologic and invasive treatment (20.3%, interquartile range 13.3–28.6) than at NICUs capable of only pharmacologic treatment (8.9%, interquartile range 2.9–14.8). Treatment rates were highest in the northeast and lowest in the west. Invasive treatment was more common in the west.

PDA diagnosis and treatment rates are trending downward. Wide variation exists in PDA treatment despite a largely uniform VLBW infant population. This variation correlates with differences in hospital treatment capabilities and geography. Further understanding of the effects of treatment disparity could aid in guiding clinical management.

动脉导管未闭 (PDA) 治疗在极低出生体重 (VLBW) 婴儿中很常见。鉴于证据有限，关于治疗风险和益处存在争议。在这项研究中，我们描述了大型美国多中心 VLBW 婴儿队列的 PDA 治疗趋势和变化。

通过佛蒙特州牛津网络收集了 2012-2019 年在美国 806 个新生儿重症监护病房出生的 291 292 名 VLBW 婴儿的数据。PDA 诊断和治疗率，进一步分类为药理学、侵入性或组合，被确定。NICU 被分为有能力和无能力进行侵入性 PDA 治疗。通过 NICU 类型和治疗四分位数检查婴儿和医院特征。美国 9 个人口普查部门描述了地理 NICU 分布和治疗率。

在所有婴儿中，24.6% 被诊断患有 PDA，20.5% 接受了 PDA 治疗。在研究期间，诊断和治疗率下降。治疗主要是药物治疗。尽管婴儿特征相似，但 NICU 的治疗率差异很大（0% 至 67%）。能够进行药物和侵入性治疗的 NICU（20.3%，四分位距 13.3-28.6）的中位治疗率​​高于仅能够进行药物治疗的 NICU（8.9%，四分位距 2.9-14.8）。东北部的治疗率最高，西部最低。侵入性治疗在西方更为普遍。

PDA诊治率呈下降趋势。尽管 VLBW 婴儿群体基本一致，但 PDA 治疗仍存在很大差异。这种差异与医院治疗能力和地理位置的差异有关。进一步了解治疗差异的影响有助于指导临床管理。