Table 1.

Ten reasons to definitively abandon PDA prophylaxis.

1) The DA closes spontaneously in 60% of patients.

2) Surgical prophylaxis cannot be recommended because it significantly increases the incidence of BPD.

3) Ibuprofen prophylaxis cannot be recommended, as it does not prevent IVH.

4) Routine indomethacin prophylaxis cannot be recommended for the prevention of long-term morbidities and mortality, especially in centers where severe IVH is comparable to the national average and surgical complications are minimal.

5) In Europe, only 5% of neonatologists use prophylaxis (data from a recent review); in the US, 23% use it.

6) The commonly used NSAIDs are associated with short-term (and probably) long-term side effects.

7) Indomethacin prophylaxis unethically exposes newborns who will never have a persistent patent DA to the side effects of drugs.

8) Differences in patient genetics, drug response, ethnicity, gender, history, and biohumoral profiles and procedures in single centers make it extremely difficult to predict the efficacy and safety of prophylaxis.

9) Epigenetic influences, which are not completely understood, may further complicate the scenario.

10) New technologies, such as pharmacogenomics and pharmacometabolomics, will allow the practice of personalized neonatal medicine.