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Background. Patent ductus arteriosus in premature infants is often treated because of its effect on pulmonary disease and the later development of bronchopulmonary dysplasia. This view has now been challenged. Materials and methods. Relevant publications have been selected from review articles in international journals, mainly through searches in the PubMed and Cochrane databases. Results. Recent research indicates that a persistent ductus arteriosus should be considered physiological in small premature infants, serving as a useful shunt allowing blood to flow from right to left during the first postnatal days when pulmonary arterial pressure is high, and from left to right in cases where significant pulmonary disease is present and increased pulmonary blood flow would improve oxygenation. A patent ductus arteriosus does not exacerbate acute pulmonary disease or increase the risk of bronchopulmonary dysplasia, intraventricular haemorrhage, necrotising enterocolitis or other complications in survivors. Interpretation. Treatment of a patent ductus arteriosus with COX inhibitors like indomethacin and ibuprofen increases the risk of bronchopulmonary dysplasia without reducing other complications or preventing death. A large patent ductus arteriosus has significant haemodynamic effects and should be treated with fluid restriction, diuretics and inotropic drugs before closure is considered. Surgical closure of a patent ductus arteriosus has been linked to neurosensory impairment in survivors.

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