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The persistent duct problem
Most neonatologists are uncertain about the optimal approach to ducts that remain patent in preterm infants. The variation in practice shows that the evidence does not strongly favour a single approach. Many clinicians prefer to treat medically or surgically at some point while some treat remarkably few. William Benitz provides a thought provoking and detailed review of the evidence, pointing out that it does not show that any approach to treatment improves clinical outcomes. The issue is clouded by the fact that in most studies where selected infants were treated, the remaining infants were also treated a little later, so there is not clear evidence that leaving them untreated is associated with favourable outcome. He says that “It would be wrong to conclude that there are no very low birthweight infants who might benefit from ductal closure. Unfortunately, we do not know precisely how to identify them …