sentence: sPDA was defined as the presence of more than 2 of the following 5 clinical symptoms with / without echocardiographic confirmation of a large left-to-right ductal flow : ( 1 ) a systolic or continuous murmur ; ( 2 ) a bounding pulse or hyperactive precordial pulsation ; ( 3 ) hypotension ; ( 4 ) respiratory difficulty ; and ( 5 ) evidence from a chest radiograph ( pulmonary congestion , cardiomegaly ) .