Oral paracetamol versus oral ibuprofen in the management of patent ductus arteriosus in preterm infants: a randomized controlled trial

J Pediatr. 2014 Mar;164(3):510-4.e1. doi: 10.1016/j.jpeds.2013.11.008. Epub 2013 Dec 18.


Objective: To compare the efficacy and safety of oral paracetamol and oral ibuprofen for the pharmacological closure of patent ductus arteriosus (PDA) in preterm infants.

Study design: This prospective, randomized, controlled study enrolled 90 preterm infants with gestational age ≤ 30 weeks, birthweight ≤ 1250 g, and postnatal age 48 to 96 hours who had echocardiographically confirmed significant PDA. Each enrolled patient received either oral paracetamol (15 mg/kg every 6 hours for 3 days) or oral ibuprofen (initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 hours).

Results: Spontaneous closure rate for the entire study group was 54%. After the first course of treatment, the PDA closed in 31 (77.5%) of the patients assigned to the oral ibuprofen group vs 29 (72.5%) of those enrolled in the oral paracetamol group (P = .6). The reopening rate was higher in the paracetamol group than in the ibuprofen group, but the reopening rates were not statistically different (24.1% [7 of 29] vs 16.1% [5 of 31]; P = .43). The cumulative closure rates after the second course of drugs were high in both groups. Only 2 patient (2.5%) in the paracetamol group and 3 patients (5%) in the ibuprofen group required surgical ligation.

Conclusion: This randomized, controlled clinical study compared oral paracetamol with ibuprofen in preterm infants and demonstrated that paracetamol may be a medical alternative in the management of PDA.

Trial registration: ClinicalTrials.gov NCT01536158.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / therapeutic use*
  • Administration, Oral
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Ductus Arteriosus, Patent / diagnostic imaging
  • Ductus Arteriosus, Patent / drug therapy*
  • Ductus Arteriosus, Patent / surgery
  • Humans
  • Ibuprofen / therapeutic use*
  • Infant, Newborn
  • Infant, Premature
  • Ligation / statistics & numerical data
  • Prospective Studies
  • Ultrasonography


  • Cyclooxygenase Inhibitors
  • Acetaminophen
  • Ibuprofen

Associated data

  • ClinicalTrials.gov/NCT01536158