We read with interest Bose and McNamara’s contributions on the management of patent ductus arteriosus (PDA) in preterm infants.1 2 Each laments the limited quality of existing data and urges the medical community to embark on a randomised trial comparing placebo with either medical treatment or surgery.

Bose and Laughon state (without citing evidence) that “the outcome following surgery is poor”, and McNamara and Sehgal that “surgical ligation may lead to irreversible major morbidity or even mortality”. Unfortunately, the widely held perception that surgical ligation is inherently the more risky therapy may cause both ethics committees and parents difficulty in agreeing to such …