Abstract
Persistent patency of the ductus arteriosus (PDA) has challenged neonatologists for more than 40 years.(,) Surgical ligation of the ductus was first performed in children nearly 80 years ago and proved that prevention of prolonged exposure to left-to-right shunting through the ductus arteriosus improved pulmonary, cardiac, and systemic outcomes. In the 1970s, the discovery that nonsteroidal anti-inflammatory drugs could induce PDA closure(–) and are effective in infants born preterm(,) provided neonatologists with a pharmacologic alternative to surgery. The clear advantages, however, of having a medical approach have been clouded by conflicting information on the long-term benefits of treatment, disagreement regarding the clinical indicators that warrant treatment for PDA, optimal drug choice, preferred dosing regimens, and indecision regarding the best time to treat a select population of fragile preterm infants.