Combination therapy for patent ductus arteriosus in preterm infants: Narrative review

Management of patent ductus arteriosus (PDA) in preterm infants remains controversial and is a matter of continuous debate with a lack of consensus among practitioners on the optimal therapeutic strategy. The success rate of the most commonly used agents for PDA closure is variable, despite different medications, dosage regimens, routes of administration, and timing or duration of treatment. Combination therapy works by inhibiting prostaglandin production at different levels on the synthesis pathway; so combining acetaminophen and nonsteroidal anti-inflammatory drugs might potentially enhance PDA closure. Few studies explored the effectiveness and safety profile of combination therapy. This review summarizes the best available evidence on the efficacy and safety profile of combination pharmacological therapy for PDA treatment in preterm infants.