Acetaminophen vs Indomethacin in Treating hsPDA

Inclusion Criteria: * Gestational age at birth 22 weeks to 31 6/7 weeks. * Birth weight ≤ 1500 grams * Day of life ≤ 21 days * ECHO findings: Left-to-right ductal flow AND 2 of the following 3: * Ductal size \> 1.5mm at smallest diameter * Reversal of flow in descending aorta * Left atrial size to aortic root ratio \>1.5 * Platelet count \> 50,000 Exclusion Criteria: * Ductal dependent congenital heart disease * Major congenital anomaly * Life-threatening infection * Urine output \< 1cc/kg/hr in prior 8 hours * Serum creatinine \> 1.8 mg/dL * Hyperbilirubinemia requiring exchange transfusion * Active NEC Stage 2 or 3 using Bell's staging criteria * Active intestinal perforation * Liver dysfunction \[2x upper limit of normal for aspartate aminotransferase(AST) and/or alanine aminotransferase (ALT)\] * Active GI bleeding * Concurrent hydrocortisone use * Known IVH Grade 3 or 4