We thank the readers for highlighting clinically valid important points related to our trial on paracetamol in treatment of patent ductus arteriosus (PDA) [1] in preterm infant. The high closure rates of PDA in our study is direct reflection of adopting the "targeted treatment" strategy. It has been shown in the past that a ductal diameter of 1.5 mm or greater has a sensitivity of 81% and specificity of 85% in predicting subsequent development of clinically symptomatic PDA [2]. All three treatment strategies in treatment of PDA in preterm neonates have one or the other drawback. In prophylactic mode, we end up treating approximately 50% infants who are not destined to develop significant PDA. If we adopt therapeutic approach, we treat when infant becomes clinically symptomatic and the response to therapeutic interventions is expected to be 50 to 80% with risk of reopening in some cases. While adopting targeted therapy, we are doing the balancing act between the prophylactic and therapeutic strategies. We, however; may be over-treating approximately 20% cases not destined to develop symptomatic PDA later [2]

We believe that closing an echocardiographically proven significant PDA only when the child develops complications may be too late!

1. Dash SK, Kabra NS, Avasthi BS, Sharma SR, Padhi P, Ahmed J. Enteral paracetamol or intravenous indomethacin for closure of patent ductus arteriosus in preterm neonates: A randomized controlled trial. Indian Pediatr. 2015; 52:573-8.