Patent ductus arteriosus (PDA) poses a diagnostic and therapeutic dilemma for clinicians. Diagnosis of persistent PDA and determination of its clinical and hemodynamic significance are challenging. Although the condition has been associated with substantial neonatal morbidities such as intraventricular hemorrhage, bronchopulmonary dysplasia, and necrotizing enterocolitis, most therapeutic approaches have failed to show improvement in these outcomes. As such, clinicians have tended toward conservative management strategies; however, the benefits and risks of such an approach are unclear. In this review, we explore various clinical diagnostic modalities, echocardiographic parameters for assessment of shunt presence, shunt volume and its effect on cardiovascular and hemodynamic status, and challenges in determining if a PDA is hemodynamically significant and clinically relevant. From the therapeutic aspect, we review current evidence on conservative, pharmacological, and mechanical (surgical or nonsurgical ligation) approaches to PDA closure. Dose, route, duration, and comparison of pharmacological strategies are reviewed, with implications for future research.