A 32-week gestation neonate is on mechanical ventilation for RDS. Surfactant was given at 2 hours of life. On day 3, the baby develops increasing oxygen requirements, bounding pulses, widened pulse pressure, and a continuous murmur at the left upper sternal border. Echocardiography confirms a large hemodynamically significant patent ductus arteriosus (hsPDA). What is the CURRENT preferred pharmacological treatment for hsPDA in a 32-week neonate?
- A Indomethacin (non-selective COX inhibitor) — drug of choice
- B Ibuprofen (selective COX-2 inhibitor with fewer renal side effects vs indomethacin)
- C Oral acetaminophen (paracetamol) as first-line due to fewer adverse effects ✓
- D Digoxin to reduce cardiac work
Explanation
Recent evidence and guidelines support oral/IV acetaminophen (paracetamol) as a first-line treatment for hemodynamically significant PDA in preterm neonates due to its comparable efficacy to indomethacin and ibuprofen with a more favorable safety profile: fewer adverse effects on renal function, cerebral blood flow, and platelet function. Multiple RCTs and meta-analyses (including NeoTreat trial data) show similar PDA closure rates. Indomethacin historically was the standard drug; ibuprofen has fewer renal side effects than indomethacin but both have more adverse effects than paracetamol. Current NICE and many neonatology guidelines now recommend paracetamol as preferred.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.