We were surprised with the results of the trial on closure of patent ductus arteriosus (PDA) in preterm neonates, recently published in Indian Pediatrics [1]. The closure rate of PDA was 100% and 94.6% in paracetamol group and indomethacin group, respectively, which is phenomenally higher than the expected closure rates. The reasons cited for the higher closure rates were higher mean gestational age and spontaneous closure of PDA, but this may not be true [2,3]. The mean gestational age was 28.5 weeks and 28.9 weeks for paracetamol and indomethacin groups, respectively. Although the enrolment criteria for 2D Echocardiography was within 48 hours, it was performed earlier (around 15 hours) which categorizes the intervention to early targeted therapy. Targeting the PDA early could result in unnecessary closures, even though it may be hemodynamically significant. Closing the duct without clinical consideration of its impact on the neonate may subject the neonate to hazardous interventions. This study has taken only echocardiographic evidence of ductus arteriosus without clinical consideration. Classifying the ductus as hemodynamically significant based on its size, irrespective of gestational age, is also questionable. The future studies should aim at timing of intervention (early targeted versus symptomatic) with single drug to answer when to treat. Similarly, the rationale to treat based on indications like need of ventilation, pulmonary hemorrhage, significant hypotension will address the issue of "to treat or not to treat the PDA".

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.

2. Yurttutan S. Paracetamol for closure of patent ductus arteriosus. Indian Pediatr. 2015;52:568-9.