Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus

To the Editor: Hundscheid et al. (March 16 issue)(1) found that expectant management for patent ductus arteriosus (PDA) was noninferior to early ibuprofen treatment with respect to necrotizing enterocolitis, bronchopulmonary dysplasia, or death at 36 weeks' postmenstrual age. However, the authors did not discuss that 25% of the infants in the expectant-management group and 38% of those in the early-ibuprofen group received paracetamol (acetaminophen), a drug that is increasingly used for PDA closure with moderate-certainty evidence suggesting that there is little or no difference in effectiveness between acetaminophen and ibuprofen.(2) The fact that almost half the infants in the trial . . .

Automated summary

This article discusses the management of patent ductus arteriosus (PDA) and finds that expectant management is noninferior to early ibuprofen treatment in preventing complications and death. However, the study did not consider the fact that a significant percentage of infants in both groups also received acetaminophen, which has been found to have similar effectiveness to ibuprofen for PDA closure.