Can ibuprofen or paracetamol effectively treat PDA in preterm infants?
Patent ductus arteriosus (PDA) is a common heart condition in preterm infants where a blood vessel fails to close after birth. When it causes symptoms (hemodynamically significant PDA, or hsPDA), doctors often consider medical closure with ibuprofen or paracetamol (also called acetaminophen). Both drugs are options, but recent large trials question whether active treatment improves outcomes compared to simply monitoring the infant.
What the research says
A 2025 clinical report from the American Academy of Pediatrics states that medical closure of an hsPDA using ibuprofen or acetaminophen is an option 5. A 2023 Cochrane overview of systematic reviews also includes ibuprofen and acetaminophen among the pharmacological interventions studied for PDA 6. A retrospective cohort study of preterm infants found that both intravenous paracetamol and ibuprofen were used for treatment, and the study analyzed predictors of response 3. However, a large 2026 randomized clinical trial (the PDA Trial) compared expectant management (monitoring) to active treatment with acetaminophen, ibuprofen, or indomethacin in infants born at 22-28 weeks. The trial was stopped early because the expectant management group had higher survival without bronchopulmonary dysplasia, suggesting no benefit from early medical closure 7. The 2025 clinical report also notes that recent trials show no benefit of prophylactic or early (<2 weeks of age) medical closure compared to expectant management 5. Therefore, while ibuprofen and paracetamol can close a PDA, the decision to use them depends on timing and clinical context.
What to ask your doctor
- Is my baby's PDA considered hemodynamically significant and likely to benefit from medication?
- What are the potential side effects of ibuprofen or paracetamol for my preterm infant?
- Would expectant management (monitoring without medication) be a reasonable option based on my baby's age and condition?
- If medication is recommended, which drug (ibuprofen or paracetamol) is preferred for my baby's specific situation?
- What are the criteria for deciding if medical treatment has failed and if procedural closure (surgery or catheter) should be considered?
This question is drawn from common patient questions about Pediatrics and answered using cited medical research. We do not provide individualized advice.