Advanced Concepts and Controversies in the Recognition and Management of Patent Ductus Arteriosus in Premature Infants.

The patent ductus arteriosus (PDA) remains one of the most debated topics within neonatology. Despite thousands of studies, there is significant heterogeneity in management practices. Although pharmacologic therapy results in increased ductal closure, no randomized controlled trial has definitively reported reduced PDA-related morbidities. We will discuss advanced concepts and controversies in the recognition and management of the PDA and highlight nuance frequently missing from interpretations of PDA-focused trials, explore issues which have precluded previous research from establishing a causal link between ductal patency and neonatal morbidity, and suggest directions for future studies investigating the potential merits of targeted ductal closure.