Hi

there seem to be enough evidence about the lack of beneficial effect of treatment of the PDA!

The approach to a hemodinámica significant ductus has changed significantly in the last 10 years. 
Years ago we weee so obsessed that indocin prophylaxis was standard in many NICUs and early treatment became standard across the board. 
I remember going to Dr Clayman  PDA lecture at PAS where the PDA was seen as a demon

many babies had  been exposed to surgical ligation with a known consecuentes of a surgery on a small premie baby 

since William Benitez published his meta analysis about PDA there has been a definitive change in some centers on how to approach it and some has gone away from early treatment and surgery 

there are other centers that continue to ignore the Trent and treat the PDA like we used to 10 years ago.

we I have noted in my practice is that regardless of the PDA size; baby that are on Mechanical ventilation after 7-10 days we give a course of tapering Decadeon (DATRT) and they get extubated

i Belice fluid/sedation/lung protective strategy and steroids when use appropriately will result in better outcomes for our micro premie of 22-26 weeks

whats are you doing in your practice?

thanks