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Model 1 adjusted for gestational age; model 2, for gestational age, sex, and birthweight z score; model 3, for gestational age, weighted by the inverse of the propensity score; model 4, for gestational age, weighted by the inverse of the propensity score and with analysis accounting for clustering on neonatal units. The position of each square represents the point estimate of the exposure effect. Less pharmacological closure and more supportive management have been observed without evidence to support these changes. Two main analyses were performed to adjust for potential selection bias, one using propensity score matching and one using neonatal unit preference for early screening echocardiography as an instrumental variable. The secondary outcomes were major neonatal morbidities pulmonary hemorrhage, severe bronchopulmonary dysplasia, severe cerebral lesions, and necrotizing enterocolitis. Exposed infants were treated for PDA more frequently during their hospitalization than nonexposed infants Exposed infants had a lower hospital death rate No differences in rates of necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions were observed. In the overall cohort, instrumental variable analysis yielded an adjusted OR for in-hospital mortality of 0.
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