Paracetamol versus ibuprofen as first-line treatment for patent ductus arteriosus: An updated systematic review and meta-analysis of randomized controlled trials

After over four decades of clinical investigation, the management of patent ductus arteriosus (PDA) in premature neonates remains highly contradictious, with no consensus on the optimal timing and approach for intervention. A systematic review and meta-analysis of randomized controlled trials were conducted using databases including Google Scholar, PubMed, and Scopus. The primary outcomes evaluated included closure rates, complications, mortality, and duration of hospitalization. A total of ten studies involve 986 premature infants diagnosed with PDA were analyzed. The study findings indicated comparable primary closure rates between paracetamol and ibuprofen treatments (RR, 1.01; 95 % CI, 0.94–1.08; P = 0.78), although fewer complications were observed in the paracetamol-treated group (RR, 0.85; 95 % CI, 0.71–1.01; P = 0.07). Moreover, the duration of hospital stay was shorter in infants treated with paracetamol (SMD, −0.24; 95 % CI, −0.47,-0.00; P = 0.05), while mortality rates did not significantly differ between groups (RR, 0.72; 95 % CI, 0.48–1.08; P = 0.11). These findings suggest that paracetamol may be an effective initial therapeutic option for managing PDA in premature infants. However, further trials are necessary to establish optimal dosing regimens, treatment durations, and potential long-term effects associated with this approach.