Closure of the ductus arteriosus

There are a number of approaches:

• in a neonate in intensive care fluid restriction may be a first line of management
• indomethacin inhibits prostaglandin synthesis and may cause closure of the ductus
• Some evidence suggests that ibuprofen may be just as effective as indomethacin and less toxic particularly to the kidneys.
• surgical ligation may be undertaken following medical correction of any signs of heart failure

A systematic review concluded (1):

• High-certainty evidence shows that indomethacin is effective in closing a symptomatic PDA compared to placebo or no treatment in preterm infants. Evidence is insufficient regarding effects of indomethacin on other clinically relevant outcomes and medication-related adverse effects

Reference:

• Evans P et al. Indomethacin for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD013133. DOI: 10.1002/14651858.CD013133.pub2