Patent ductus arteriosus: time to grasp the nettle?

The management of patent ductus arteriosus is controversial, and there are diverse approaches to treatment, ranging from very conservative management through to early and aggressive securing of ductus closure, either pharmacologically or surgically. This lack of consensus on best management reflects a paucity of high quality randomised controlled trials, with many published studies focusing on establishing points of treatment, rather than looking for benefits of intervention over more conservative management. Despite this lack of good evidence views on ductus management can be entrenched, with accompanying loss of equipoise. This review looks at our current situation with regard to ductus arteriosus management and the need for good quality trials especially in the light of other published studies, concerning postnatal steroids, caffeine and oxygen which have demonstrated unexpected benefits - or sometimes unexpected harm - from long-familiar drugs.