Ibuprofen vs. acetaminophen for PDA closure in preterm infants

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Created On: 24/03/2026

Patent ductus arteriosus (PDA) is a common cardiovascular ailment in preterm newborns and is associated with increased neonatal morbidity and mortality.

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Key take away

Ibuprofen outperforms acetaminophen in promoting patent ductus arteriosus closure, particularly in infants >32 weeks gestation and >1500 g birth weight.

Background

Patent ductus arteriosus (PDA) is a common cardiovascular ailment in preterm newborns and is associated with increased neonatal morbidity and mortality. Pharmacological therapy is frequently used to promote ductal closure, yet comparative clinical evidence between commonly used agents remains important for neonatal care decisions. The effect of ibuprofen on PDA closure was compared with acetaminophen and no pharmacological treatment in preterm newborns.

Method

The study included 327 preterm neonates with a gestational age below 37 weeks and a birth weight of less than 2500 grams. Newborns were randomly assigned to receive ibuprofen, acetaminophen, or no pharmacological treatment (control group). Echocardiography was carried out on the third day after birth and on the first day after completion of treatment to evaluate PDA closure. Statistical analysis was executed via Statistical Package for the Social Sciences version 22, with statistical significance defined as a p-value below 0.05.

Result

In this randomized clinical trial, PDA closure rates differed considerably among the groups, with the ibuprofen group showing superior outcomes compared to the acetaminophen and control groups (p = 0.012). In neonates with a gestational age greater than 32 weeks, ibuprofen achieved a 100% PDA closure rate, which was substantially higher than that observed with acetaminophen (p < 0.05). Ibuprofen also demonstrated better closure rates compared with the control group (χ² = 9.244, p = 0.002).

Among infants weighing more than 1500 grams, prominent differences in PDA closure were observed across all group comparisons, with ibuprofen consistently showing the highest closure rates. Binary logistic regression analysis revealed that PDA closure was markedly associated with treatment type and pre-treatment PDA size, while sex, gestational age, and birth weight did not show a noticeable association.

Conclusion

Ibuprofen administration was connected with higher PDA closure rates compared with acetaminophen and no treatment in preterm newborns, particularly among those with gestational age above 32 weeks and birth weight above 1500 grams.