**4. Conclusion**

The PDA is common morbidity in preterm infants. There has been a trend towards more conservative management over surgical treatment [51]. The pharmacological treatment causes ductal constriction with good effectiveness overall whether using NSAIDs or acetaminophen in different routes of administration. However, complete ductal closure or shunt elimination cannot be guaranteed even when combining these agents together; this is in addition to potential adverse side effects.

Recently, FDA approved the use of Piccolo device for the purpose of PDA closure in preterm infants which was based of the efficacy and safety of such a device in this fragile population [2]. It appears that this catheter closure approach is becoming more popular as it is feasible, effective, and relatively safe [19, 52]. Whether this approach would result in more favorable neonatal morbidities and outcomes, needs further research.
