Background <p>Although serum NT-proBNP is a useful marker of patent ductus arteriosus (PDA) severity in the early postnatal period, its ability to predict the future need for PDA surgery remains unclear. This study aimed to compare the predictive abilities of early NT-proBNP and the PLASE score using an established echocardiographic model.</p> Methods <p>Infants born at 23–29 weeks of gestation between 2019 and 2024 and admitted to a tertiary neonatal intensive care unit were included. Serum NT-proBNP levels and echocardiographic indices at 3 days of age were retrospectively collected. Three predictive models were evaluated: Model 1, the PLASE score (reference); Model 2, log₁₀(NT-proBNP); and Model 3, log₁₀(NT-proBNP) plus gestational age (weeks).</p> Results <p>Among 126 infants included, 23 (18%) underwent PDA surgery. The ROC-AUCs (95% CI) were 0.829 (0.748–0.910) for Model 1, 0.669 (0.539–0.798) for Model 2, and 0.826 (0.741–0.911) for Model 3. Model 1 yielded higher ROC-AUC than Model 2 (<i>p</i> = 0.02), whereas no significant difference was observed between Model 1 and Model 3 (<i>p</i> = 0.94).</p> Conclusions <p>Early postnatal NT-proBNP combined with gestational age showed high predictive ability comparable to the PLASE score. NT-proBNP could be used to estimate the likelihood of future PDA surgery.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>N-terminal pro-B-type natriuretic peptide (NT-proBNP) measured at 3 days of age, when combined with gestational age, demonstrated high predictive ability for patent ductus arteriosus (PDA) surgery (Area under the receiver operating characteristic curve: 0.826).</p> </ItemContent> <ItemContent> <p>Early postnatal NT-proBNP yielded results equivalent to those of the PLASE score, an echocardiographic prediction model.</p> </ItemContent> <ItemContent> <p>This study suggests that early NT-proBNP assessment may complement echocardiographic evaluation in the management of PDA.</p> </ItemContent> </UnorderedList></p>