Acetaminophen for the treatment of patent ductus arteriosus in the preterm newborn: a systematic review

The ductus arteriosus is a vital vascular structure in fetal life, however, its persistence after birth has been associated with increased morbidity and mortality. Acetaminophen has recently been proposed as an alternative for its pharmacological closure, however, information about its safety and effectiveness profile is required. Objective: To evaluate the efficacy, safety, and cost-benefit ratio of acetaminophen in neonates for the closure of patent ductus arteriosus. Material and Method: Systematic review according to the PRISMA guidelines, between 2019 and 2023 in the PubMed and Embase databases of the use of acetaminophen in neonates for the closure of patent ductus arteriosus (PDA). Results: 210 studies were identified and, after applying the inclusion and exclusion criteria, 36 were selected, which were classified into 7 categories of analysis and description. Most studies have a limited number of premature patients under 28 weeks, who have a high percentage of PDA. It is concluded that acetaminophen has an efficacy for PDA closure between 69% and 80%, decreasing when treatment is started in the second week or later. Conclusions: Current scientific evidence shows that, compared to ibuprofen and indomethacin, acetaminophen has similar success rates in the pharmacological closure of the patent ductus. A better cost-benefit profile was observed, and some elements suggest a decrease in adverse effects.