A randomized trial comparing immediate medication versus watchful waiting for patent ductus arteriosus in extremely preterm infants (22-28 weeks gestation) found no significant difference in death or bronchopulmonary dysplasia rates between approaches. The study challenges the long-standing practice of routinely medicating this common heart condition in premature babies. This finding represents a potential shift in neonatal intensive care protocols, where patent ductus arteriosus affects up to 70% of extremely preterm infants. The condition involves a blood vessel that normally closes after birth but remains open in premature babies, potentially causing heart and lung complications. The equipoise between active treatment and expectant management suggests that the cardiovascular stress from keeping the ductus open may be balanced by medication-related risks in this vulnerable population. For parents facing this decision, the research indicates that immediate intervention may not always be necessary, though individual clinical factors remain important. The trial's design likely involved careful monitoring protocols for the expectant management group, representing a more conservative approach that could reduce medication exposure in already fragile infants.