Management of the PDA Trial

This is a pragmatic randomized multicenter, effectiveness study comparing active treatment of
a symptomatic patent ductus arteriosus (sPDA) to expectant management. We hypothesize in
premature infants with a sPDA, expectant management reduces the incidence proportion of death
or BPD by 10% (from 50% to 40%) when compared to active treatment.

Participants with a sPDA allocated to the active treatment arm will receive intravenous
administration of indomethacin or ibuprofen (depending on center preference). The decision to
ligate will be left to the clinical team. Participants with a sPDA allocated to the expectant
management arm will receive supportive care at the clinical team's discretion and will
receive indomethacin/ibuprofen or ligation if the infant develops cardiopulmonary compromise.
The decision to ligate will be left to the clinical team.

The primary endpoint for the study will be death or BPD (as assessed by the physiologic
definition) at 36 weeks postmenstrual age (PMA).

Inclusion Criteria:

- Postnatal age 48 hours -21 days

- Infant 22 0/7 to 28 6/7 weeks gestation at birth

- sPDA, as defined as:

1. Mild, Moderate, or Severe Clinical Criteria with Small or Moderate size PDA on
echocardiogram

2. Mild or Moderate Clinical Criteria with Large PDA on echocardiogram

Exclusion Criteria:

- Cardiopulmonary compromise

- Known congenital heart disease (besides atrial septal defect or ventricular septal
defect)

- Known pulmonary malformation (e.g. congenital lobar emphysema, congenital pulmonary
adenomatous malformation)

- Any condition which, in the opinion of the investigator, would preclude enrollment