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In infants who are born at 28 weeks gestation or later, a PDA is usually not treated until two or more hemodynamic signs and symptoms are present, that is, increased pulse volume or widened pulse pressure, hyperactive precordium, increased pulmonary vascular markings on chest X ray, or echocardiographic findings of left ventricular enlargement, and/or holodiastolic reversal of flow in the descending aorta. Table 2 summarizes one approach for the dosing of indomethacin based upon birth weight and gestation.Limited evidence based outcomes with regard to direct comparative strategies impede the ability to reach the depth of consensus needed when treating a PDA in infants who are born at 28 weeks gestation or later. While the PDA clearly plays a role in the development of the reversible changes in pulmonary mechanics that result from pulmonary edema, its role in producing other long term irreversible pulmonary morbidities, like pulmonary remodeling and chronic lung disease, have yet to be demonstrated.
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