Prophylactic Indomethacin—Is It Time to Reconsider?

Despite decades of clinical experience, hundreds of publications on the topic, and dozens of randomized trials, the management of patent ductus arteriosus (PDA) in preterm infants remains a subject of uncertainty and controversy. The available evidence has many limitations, among which the pervasive assumption that a persistent PDA must be closed at some point and the paucity of data related to treatment choices beyond the first postnatal week may be the most consequential. Most trials reported to date have focused on treatment assignments within the first 5 days after birth, and open treatment of controls within a few days of randomization may have obscured the risk of longer exposures to the hemodynamic effects of ductal patency.

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