Early Treatment Versus Delayed Conservative Treatment of the Patent Ductus Arteriosus

Prior studies showed that, if a moderate/large Patent Ductus Arteriosus (PDA) is still
present at 5 days after birth (among infants delivered at 23 and 0/7 to 25 and 6/7 weeks
gestation) or at 7 days after birth (among infants delivered at 26 and 0/7 to 27 and 6/7
weeks gestation), it will persist for at least another 4-12 weeks if it is left untreated.

Inclusion Criteria:

This will be a prospective randomized, multi-center, controlled trial that will enroll
infants delivered between 23 & 0/7 - 27 & 6/7 weeks gestation:

1. infants must be between 5-14 days old (if delivered between 23 and 0/7 - 25 and 6/7
weeks) or 7-14 days old (if delivered between 26 & 0/7 - 27 & 6/7 weeks) and

2. have a "moderate size PDA" (defined as a PDA on echocardiogram that has at least one
of the following criteria: internal ductus diameter ≥1.5 mm/kg (or PDA:LPA ratio
≥0.5), ductus flow velocity ≤2.5 m/s or mean pressure gradient across the ductus <8
mm, LA/Ao ratio ≥1.5, left pulmonary artery diastolic (or mean) flow velocity >0.2 (or
>0.42) m/sec, respectively, and/or reversed diastolic flow in the descending
aorta)(13, 68, 69) and

3. are receiving respiratory support consisting of either mechanical ventilation, nasal
CPAP, SiPAP, or nasal cannula flow ≥2 L/min.

Exclusion Criteria:

prior treatment with indomethacin, ibuprofen, or acetaminophen, contraindications for
the use of indomethacin, ibuprofen, or acetaminophen (these include: hydrocortisone
administration within 24 hrs, urine output < 1 ml/kg/h during the preceding 8 h, serum
creatinine level >1.6 mg/dl, platelet count <50, 000/mm3, abnormal coagulation
studies, or total bilirubin concentration (in mg/dL) > 8 x weight (in kg)),
chromosomal anomalies, congenital or acquired gastrointestinal anomalies, prior
episode of necrotizing enterocolitis or intestinal perforation.