Abstract
<title>Abstract</title> <p> Background The management of preterm infants with patent ductus arteriosus (PDA) remains controversial. This study examined national PDA practices in Thailand. Methods A cross-sectional survey was conducted between July 2024 and November 2025 among board-certified pediatricians. The questionnaire assessed clinician demographics, PDA diagnostic criteria, echocardiographic assessment, and management strategies. The survey was distributed through online platforms and at national pediatric conferences. Analyzes were performed using section-specific denominators and comparisons between neonatologists and other pediatricians. Results A total of 133 pediatricians responded, including 65 neonatologists (49%). Only 29/133 (22%) reported having institutional PDA guidelines. Routine echocardiographic screening was performed 14% (n = 17) of respondents, most commonly for infants born at < 29 weeks’ gestation (11/17, 65%) and performed within the first 12–24 hours of life (10/17, 59%). Ductal diameter was the most frequently used parameter to define Hemodynamically significant PDA (104/124, 84%), whereas echocardiographic markers of pulmonary overcircultion and systemic steal were infrequently incorporated. Routine pharmacologic treatment to accelerate ductal closure was the predominant management strategy (73/119, 62%). Acetaminophen was the preferred first-line agent (63%) and was used more frequently by neonatologists than by other pediatricians (75% <italic>vs</italic> 50%; <italic>p</italic> = 0.01). In contrast, other pediatricians more frequently endorsed active PDA treatment and closure prior to discharge across clinical equipoise items. Conclusion There is substantial variation in PDA diagnostic criteria and management practices among Thai pediatricians, largely reflecting non-standardized and experience-based approaches. These findings highlight the need for national standardized guidelines to improve consistency and equity in PDA care. Trial registration: Not applicable </p>