PDA Therapy in Preterm Infants: Early Treatment (NSAID, acetaminophen or combination) versus Watchful Waiting

Drug therapy targeted for PDA closure is one of the most controversial topics, especially among preterm infants. NSAIDs have been the most widely prescribed drugs for this purpose. The argument included early drug treatment versus watchful waiting (i.e., non-pharmacological strategy) and single versus combination therapy. Previous studies concluded that early use of NSAIDs like ibuprofen resulted in a high rate of nonsurgical closure of PDAs in most treated preterm infants. Recently, the impact of early use of ibuprofen among preterm infants was studied in 2 trials. One concluded that early ibuprofen administration wasn’t related to a lower risk of death or severe bronchopulmonary dysplasia than a placebo. The other one concluded that early PDA therapy was associated with lower rates of deaths, and this effect was pronounced among groups who required invasive ventilation. Considering that acetaminophen has fewer adverse effects, a novel strategy using combination therapy (NSAID + acetaminophen) had emerged - for pharmacological PDA closure in preterm infants - as an alternative to NSAID alone with similar efficacy and fewer side effects.