We thank the reader for his comments and providing us the opportunity to further discuss the controversies in the management of PDA in VLBW infants. We agree with the reader that spontaneous closure of PDA is significantly high in VLBW infants with birth weight >1000g [1-2], and the presence of PDA is associated with significant morbidity and mortality in infants of gestational age <25 weeks [3]. However, it is not clear from the literature where to draw the demarcation line as far as the birth weight is concerned. An unpublished audit done in our department revealed that birth weight was a better predictor than gestational age with regard to PDA-related morbidities. We found that morbidities such as massive pulmonary hemorrhage and severe intra-ventricular hemorrhage were significantly higher in babies with birth weight less than 800g with untreated PDA, regardless of gestational age. Hypothermia, peri-natal asphyxia, lack of antenatal steroids and intrauterine growth retardation were additional risk factors.

If treatment for the PDA is based on clinical judgment alone, we might end up in over treating it, and exposing the neonates to treatment - related morbidities. Hence we recommend that the treatment strategies should be based on birth weight as well, in addition to hemodynamic significance of PDA and need for assisted ventilation.