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Patent ductus arteriosus (PDA) and response to late surfactant treatment in premature infants


To determine the clinical/echocardiography (ECHO) phenotype of patients with hypoxic respiratory failure (HRF) and response to late surfactant, according to patent ductus arteriosus (PDA) status.

Study design

This retrospective study included infants ≤26+6 weeks gestation who received ≥1 surfactant dose after 6 postnatal days and where PDA status was available by ECHO. Response to surfactant was appraised based on change in respiratory severity score over 48 h. The relationship between PDA status and response to surfactant was evaluated via univariate analysis.


We studied late surfactant (n = 71 doses) administration in 35 preterm infants born at a mean weight and GA at birth were 595 g (508, 696) and 23.3 (22.7, 25) weeks, respectively of whom 16 (46%) had a diagnosis of PDA. Positive response to late surfactant treatment was independently associated with absence of PDA [OR 26 (2, 334), p = 0.01] whereas presence of PDA was independently associated with negative response [OR 12 (1.1, 126), p = 0.04].


In neonates ≤26+6 weeks gestation, with HRF, response to surfactant after postnatal day 6 is influenced by PDA status. Future trials should consider PDA status which may enhance diagnostic precision and refine patient selection for late surfactant treatment.

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Fig. 1: Population description.
Fig. 2: Change in respiratory severity score following surfactant administration.
Fig. 3: Receiver operating characteristic (ROC) curve for PDA score as a predictor of positive and negative response to late surfactant.


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Authors and Affiliations



Conceptualization: MS.B, REG and PJM; Data curation: MSB, AMC, AHS, ARB, JMD, DRR, JMK, REG; Formal analysis: MSB, AHS, REG; Methodology: MSB, JMD, DRR, REG and PJM; Supervision: AHS, ARB, JMD, DRR, JMK, REG and PJM; Writing—original draft: MSB, AHS; Writing—review & editing: MSB, AMC, AHS, ARB, JMD, DRR, JMK, REG and PJM. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Patrick J. McNamara.

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The authors declare no competing interests.

Informed Consent Statement

Patient consent was waived due to the retrospective nature of the study.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the University of Iowa (protocol code 20140743).

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Beauchene, M.S., Cunningham, A.M., Stanford, A.H. et al. Patent ductus arteriosus (PDA) and response to late surfactant treatment in premature infants. J Perinatol (2023).

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