Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials

Background: Paracetamol has been suggested as an effective treatment for patent ductus arteriosus (PDA). However, the comparative efficacy and safety between paracetamol and ibuprofen were not determined.Methods: A meta-analysis of randomized controlled trials (RCTs) was performed. Relevant studies were identified via database searching. A fixed or random effect model was applied depending on the extent of heterogeneity.Results: Five RCTs with 677 neonates were included. The efficacies for the primary (risk ratio [RR]: 1.03, p=.56) and overall PDA closure were comparable between the two medications (RR: 1.02, p=.62). Neonates of the two groups were comparable for the incidence of PDA complications, including necrotizing enterocolitis (RR: 0.86, p=.70), intraventricular hemorrhage (RR: 0.84, p=.55), bronchopulmonary dysplasia (RR: 0.69, p=.16), and retinopathy of prematurity (RR: 0.58, p=.15), and the risks of sepsis (RR=0.88, p=.48) and death (RR: 1.45, p=.45) within hospitalization. However, treatment with paracetamol was associated with a trend of reduced risk of renal failure (RR: 0.20, p=.07), and a significantly reduced risk of gastrointestinal bleeding (RR: 0.28, p=.009).Conclusions: Paracetamol may confer comparable treatment efficacy for the closure of PDA as ibuprofen, although paracetamol is associated with lower risk of adverse events.