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Enteral feeding during cyclooxygenase inhibitor treatment for patent ductus arteriosus: A systematic review

Gakuto Ujiie1,2, Eriko Kobayashi3, Miyuki Inoue4

  • 1Department of Pediatrics, Showa Medical University, Shinagawa, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|February 10, 2026
PubMed

Insights

Modifying enteral feeding during cyclooxygenase inhibitor (COXI) treatment did not significantly impact gastrointestinal outcomes in preterm infants. However, discontinuing enteral feeding reduced the need for surgical closure of patent ductus arteriosus (PDA).

Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Pharmacology

Background:

  • Preterm infants often require cyclooxygenase inhibitor (COXI) treatment for patent ductus arteriosus (PDA).
  • Enteral feeding modifications during COXI therapy are explored for their impact on gastrointestinal complications.

Purpose of the Study:

  • To evaluate the effect of altering enteral feeding strategies during COXI treatment on PDA in preterm infants.
  • To assess the influence on necrotizing enterocolitis (NEC) and gastrointestinal perforation.

Main Methods:

  • Systematic search of multiple databases (MEDLINE, EMBASE, CENTRAL, CINAHL, ICHUUSHI) for relevant controlled trials.
  • Inclusion of randomized and non-randomized controlled trials, excluding non-human and non-English studies.
  • Assessment of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.

Main Results:

  • No significant difference in the composite gastrointestinal outcome (NEC or gastrointestinal perforation) between enteral feeding discontinuation and continuation (very low certainty of evidence).
  • Discontinuation of enteral feeding was associated with a significantly lower rate of surgical PDA closure (low certainty of evidence).

Conclusions:

  • Neither discontinuing nor continuing enteral feeding during COXI treatment significantly affected the composite gastrointestinal outcome or its components (NEC, gastrointestinal perforation).
  • Discontinuation of enteral feeding may reduce the need for surgical PDA closure.
Abstract

Keywords:
cyclooxygenase inhibitorsenteral nutritionnecrotizing enterocolitispatent ductus arteriosuspreterm infants

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