Universal practice based management of patent ductus arteriosus in premature neonates in 2025: BRONX PDA protocol and BRONX clinical scoring system (BCSS)

Background Management of hemodynamically significant patent ductus arteriosus (hsPDA) in neonates remains controversial, with wide variation in practice among neonatologists and pediatric cardiologists. Methods An IRB-approved anonymous 12-item survey assessing hsPDA screening, treatment preferences, and perceived risks and benefits was distributed to over 5,000 U.S. providers. Responses were statistically analyzed using standard parameters. Results A total of 462 completed surveys were analyzed (35% cardiologists, 64% neonatologists). Most providers-initiated PDA screening based on clinical condition. Medical therapy was the preferred first-line treatment. Nearly one-third favored conservative management when echocardiographic hsPDA was present with minimal clinical concern, while others delayed intervention beyond the neonatal period. Pediatric cardiologists were more likely than neonatologists to believe PDA closure reduces morbidity and mortality, although most providers still elected to treat hsPDA. Neonatologists favored medical and percutaneous approaches over surgery. Conclusion Significant inter-specialty variation persists in hsPDA management, highlighting the need for standardized, clinically integrated approaches.