Premature infants with a patent ductus arteriosus (PDA) are at increased risk of more prolonged and more severe respiratory distress syndrome, bronchopulmonary dysplasia, and death than similar infants whose ductuses have closed. In an attempt to improve the outcome for these infants, three broad strategies have been proposed: prophylactic “closure”, closure of the asymptomatic but clinically detected PDA, and closure of the symptomatic PDA. Interventions, some of which have been subjected to more rigorous scrutiny than others, used as part of these strategies include fluid restriction, the use of diuretics, the use of cyclo-oxygenase inhibitors, and surgical closure using a variety of surgical techniques. There are now seven completed systematic reviews in the Cochrane library looking at such interventions.¹ The bulk of the evidence available assesses the impact on short term outcomes, with some of the strategies resulting in, for example, an …