Management of patent ductus arteriosus (PDA) in preterm infants has shifted markedly toward restraint. The BeNeDuctus trial showed that expectant management was non-inferior to early ibuprofen for the composite of necrotizing enterocolitis, moderate-to-severe bronchopulmonary dysplasia, or death — and the Baby-OSCAR trial found no benefit of early ibuprofen treatment of large PDAs over placebo. Together these support a more conservative, watchful approach in many preterm infants rather than routine early pharmacologic closure. Combination pharmacotherapy with acetaminophen plus ibuprofen has shown higher closure rates in small studies but needs larger trials. For infants who do need closure, transcatheter device occlusion (with a dedicated device now available for very small premature infants) has become a viable alternative to surgical ligation.
Further reading: BeNeDuctus trial (expectant management vs ibuprofen, NEJM 2024); Baby-OSCAR trial; reviews of combination pharmacotherapy for PDA.