Time to Stop Early Treatment of Patent Ductus Arteriosus?

This NEJM editorial reviews the BeNeDuctus trial findings and challenges the practice of early pharmacologic treatment (e.g., ibuprofen) for patent ductus arteriosus (PDA) in extremely preterm infants. The trial randomized 273 infants (<28 weeks’ gestation) with echocardiographically confirmed PDA to receive either early ibuprofen or expectant management. Noninferiority was demonstrated for expectant management, with a lower rate of moderate-to-severe bronchopulmonary dysplasia (33.3% vs. 50.9%). Death, necrotizing enterocolitis, and other outcomes were similar across groups. The authors underscore that many PDAs close spontaneously, and early treatment may introduce harms like acute kidney injury or gastrointestinal bleeding. The editorial encourages risk stratification approaches and calls into question universal early pharmacologic PDA closure, pending long-term neurodevelopmental outcomes at 24 months.

This NEJM editorial reviews the BeNeDuctus trial findings and challenges the practice of early pharmacologic treatment (e.g., ibuprofen) for patent ductus arteriosus (PDA) in extremely preterm infants. The trial randomized 273 infants (<28 weeks’ gestation) with echocardiographically confirmed PDA to receive either early ibuprofen or expectant management. Noninferiority was demonstrated for expectant management, with a lower rate of moderate-to-severe bronchopulmonary dysplasia (33.3% vs. 50.9%). Death, necrotizing enterocolitis, and other outcomes were similar across groups. The authors underscore that many PDAs close spontaneously, and early treatment may introduce harms like acute kidney injury or gastrointestinal bleeding. The editorial encourages risk stratification approaches and calls into question universal early pharmacologic PDA closure, pending long-term neurodevelopmental outcomes at 24 months.