Abstract. There are inconsistencies in the diagnosis of hemodynamically significant Patent Ductus Arteriosus (hsPDA) and the decision to treat it in preterm neonates. Since hsPDA is related to poor outcomes, there is need for an easier, inexpensive and point of care method to diagnose and evaluate the effect of treatment on hsPDA. While echocardiography is the gold standard for the diagnosis and evaluation of treatment, it has certain pitfalls including a lack of universal availability, and when available, has significant intra and inter-observer variability. Recently, the detection of natriuretic peptides and their correlation to the size of PDA provides a possibility for development of a simple bedside test for the diagnosis and management of hsPDA for the intensivists treating preterm neonates. There are certain aspects of natriuretic peptides including its associations with gestationalage, days of life, presence of co-morbidities and the type of assay performed that need to be studied further before it can be used as a routine bedside test. The aim of this review is to analyze the existing literature on the use of natriuretic peptide in the diagnosis and management of hsPDA in preterm neonates and its strengths and limitations.