Paracetamol (acetaminophen) has been proposed as an alternative medication for closing hemodynamically significant patent ductus arteriosus (PDA).

However, the clinical outcomes remain inconclusive in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.

The aim of this study was to compare the efficacy and safety of oral paracetamol and ibuprofen for pharmacological closure of PDA in premature infants from a real-world study.

This retrospective study enrolled 255 preterm infants with birthweights of ≤1.5 kg, and echocardiographically confirmed significant PDA. Subjects were classified into 3 groups: Group I (standard-dose ibuprofen group) received 10 mg/kg oral ibuprofen followed by 5 mg/kg/day for 2 days.

Group II (high-dose ibuprofen group) received 10 mg/kg/day oral ibuprofen for 3 days. Group III (paracetamol group) received 15 mg/kg/6 h oral paracetamol for 3 days.

This study demonstrated that paracetamol may be a poor medical alternative for PDA management in VLBW and ELBW infants. High dosage ibuprofen was associated with a faster clinical improvement and higher rate of PDA closure.