In Reply.—

We appreciate Dr Manzar's comments on our high-dose indomethacin treatment strategy for the closure of symptomatic patent ductus arteriosus (sPDA) in premature infants and thank the editor for the opportunity to reply. Our initial rationale for treating infants suffering from sPDA with high doses of indomethacin was based less on reports that overdosages of indomethacin did not lead to severe adverse effects and more on the opportunity to closely follow-up on adverse effects and on the treatment success (measured by daily echocardiography). In addition, it has to be emphasized that our strategy does not consist of a high-dose approach per se. High doses of the drug were used only in those infants who had insufficient closure of the duct during standard treatment. This resulted in a surprisingly low number of infants who actually received high doses of the drug. We have to admit (having the Western...

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