Emerging treatments
Acetaminophen
Acetaminophen has been investigated as an alternative pharmacologic treatment to indomethacin or ibuprofen in preterm infants. One systematic review found no significant difference in PDA closure rates between acetaminophen and ibuprofen or indomethacin; however, acetaminophen caused fewer adverse effects, with a significantly reduced risk of oliguria and a tendency towards less gastrointestinal bleeding.[96] Another systematic review found a lack of high quality evidence to recommend acetaminophen as a primary treatment for PDA.[97]
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An overview of 16 Cochrane Reviews found that all available drug therapies, that is, indomethacin, ibuprofen, and acetaminophen (specifically when given early), were effective in closing a PDA in preterm infants. The evidence on the effect of prophylactic acetaminophen on severe intraventricular hemorrhage (IVH) was very uncertain (whereas indomethacin and ibuprofen were both found to reduce severe IVH).[55] Further study is warranted before acetaminophen can be adopted as the standard of care.[59][61]
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