Pharmacologic Management of Patent Ductus Arteriosus in the Neonatal Intensive Care Unit: A Retrospective Study

Patent ductus arteriosus (PDA) is common in premature neonates. The use and selection of pharmacologic therapy are controversial because of unclear long-term benefits and the potential of adverse effects. The objective of this review was to explore the safety and efficacy for indomethacin, ibuprofen, and acetaminophen for PDA management.

A chart review was conducted for neonates who received pharmacologic treatment for PDA at our institution between July 1, 2016, and May 30, 2023. Data collected included treatment success or failure; adverse reactions to the medications, including renal dysfunction, gastrointestinal perforation or bleeding, hepatotoxicity, and/or death; and complications, including bronchopulmonary dysplasia, pulmonary hypertension, surgical closure, and death before discharge.

A total of 91 neonates met the inclusion criteria. The efficacy rates for the first treatment course were 25 of 31 (80.6%) for indomethacin, 4 of 16 (25%) for ibuprofen, and 27 of 44 (61.4%) for acetaminophen. Complications occurred in 12 of 31 (38.7%) for indomethacin, 9 of 16 (56.3%) for ibuprofen, and 0 of 44 (0%) for acetaminophen.

Indomethacin and acetaminophen had good efficacy, though indomethacin had a high incidence of complications. Ibuprofen had lower efficacy than expected (25%) and concerning safety outcomes, which requires further investigation to see if ethnicity plays a role.