Background and aims Management of patent ductus arteriosus (PDA) is still a dilemma. We aimed to prove that a more conservative approach of PDA is equally effective without increasing morbidity-mortality in preterm infants.

Methods From January 2009 to December 2013 clinical charts of preterm <31 weeks admitted into two NICUs with clinical/echocardiographic PDA were analysed. In January 2011 management was changed. In the first period (P1), patients who failed medical treatment underwent surgical ligation; in the second (P2), only those with cardiopulmonary compromise (mainly those that could not be weaned from ventilator). We compared survival-without-morbidity, defined as patients discharged without chronic lung disease, severe retinopathy, necrotizing enterocolitis or severe intraventricular haemorrhage.

Results Patients in P1 (n = 63) and P2 (n = 88) had similar clinical characteristics. Significant lower rates of medical (85.7% vs 56.8%) and surgical treatment (33.9% vs 14.3%) were observed in P2. No differences in survival-without-morbidity were observed (Table 1). In P2, 19.4% patients showed PDA at discharge.

Conclusions A conservative approach in preterm with PDA can avoid medical/surgical treatment and its side effects, without changes in survival-without-morbidity.