Management of the patent ductus arteriosus (PDA) represents an ongoing challenge in the
care of extremely premature neonates. Determining the optimal treatment strategy requires careful
consideration of the potential risks and benefits of available therapies. Surgical ligation results in reliable
ductal closure, but may result in numerous short-term complications and have a negative impact
on long-term outcome. Intravenous indomethacin was the first pharmacologic agent widely utilized
for PDA closure. Intravenous indomethacin effectively closes the ductus arteriosus and prevents pulmonary
hemorrhage and severe intraventricular hemorrhage, but fails to mitigate short-term morbidities
and improve long-term outcomes. Intravenous ibuprofen represents an alternative therapy with fewer renal adverse
effects. However, intravenous ibuprofen does not prevent severe intraventricular hemorrhage and also has concerning adverse
effects, including bilirubin displacement and the potential to increase the risk of chronic lung disease. Enteral ibuprofen
has also been investigated, although gastrointestinal adverse effects limit widespread utilization. Acetaminophen
(paracetamol) represents an enticing novel therapy due to wide availability, low cost, and an appealing safety profile. Ongoing
investigation is required to determine the role of this agent in PDA treatment algorithms. Pending these results, clinicians
must weigh the potential risks and benefits of each therapy for individual neonates considering all available evidence.
Keywords: Acetaminophen, ibuprofen, indomethacin, patent ductus arteriosus, pharmacotherapy, premature infant.
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