The diagnosis of a patent ductus arteriosus (PDA) in preterm neonates is unreliable based on clinical and radiographic findings and requires the use of echocardiography (1). The incidence of a PDA diagnosed by echocardiography in neonates with a birth weight of less than 1750 g is 43% (2). The presence of a PDA is associated with reduced middle cerebral artery blood flow velocity (3). A PDA is associated with an increased risk of intraventricular hemorrhage, necrotizing enterocolitis, chronic lung disease, and death (4).

Historically, progress in the management of the preterm infant with a PDA includes surgical closure introduced in the early 1970s by Kitterman et al. (5) and the use of i.v. indomethacin, a prostaglandin synthesis inhibitor introduced by Heyman et al. (6) and Friedman et al. (7) in the mid-1970s. Later it was shown in randomized controlled trials that the prophylactic use of indomethacin in infants at risk of a clinically significant PDA reduces the risk of a symptomatic PDA and severe intraventricular hemorrhage, but the effectiveness with regard to long-term neurodevelopment outcomes was poorly ascertained (2). As indomethacin reduces cerebral blood flow velocity (CBFV) (8), treatment of a PDA with indomethacin may contribute to the development of periventricular leukomalacia, a condition associated with a very high risk for adverse neurodevelopmental outcome. The proven effectiveness of indomethacin in reducing the incidence of intraventricular hemorrhage might therefore be counteracted by an increase in periventricular leukomalacia, and as a result there would be no net gain in the number of neonates with normal neurodevelopmental outcome. The recruitment phase of an ongoing international multicenter trial of prophylactic treatment with indomethacin to assess its effectiveness in reducing long-term adverse outcomes has been completed [Trial of Indomethacin Prophylaxis in Preterm Infants (TIPP)]. Results on the primary outcome of death or impairment at 18–21 mo corrected gestational age will be available in the year 2000 (B. Schmidt, Mc Master University Hamilton, Ontario, Canada, 1999, personal communication).

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