Paracetamol in Patent Ductus Arteriosus, "Flavour of the Month" or Here to Stay?

Though spontaneous closure of the ductus is the norm in term newborns, two-thirds of very low birth weight (VLBW) babies have spontaneous closure in the first seven days of life and only 30% of extremely low birth weight (ELBW) close their ductus during the neonatal period [1]. A PDA in a VLBW baby is associated (though not causal) with adverse outcomes like bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and death [2]. However, trials have not shown any definite change in these outcomes by treating a PDA. Treatment of PDA thus remains one of the most debated topics in neonatal medicine with no consensus on whether to treat, and when and how to treat! Nick Evans aptly calls it a “conundrum” [2-4]. Be that as it may, most neonatologists would prefer to attempt ductal closure in preterm neonates with symptoms or in those on respiratory support.