For an infant with respiratory distress syndrome and a symptomatic patent ductus arteriosus, which pharmacologic option is supported as effective?

• A. Ibuprofen
• B. Indomethacin
• C. Both of the above drugs are equally effective
• D. Neither drug is effective

Answer: (C)

Ductus closure in preterm infants hinges on prostaglandins keeping the vessel open; NSAIDs block prostaglandin synthesis, prompting constriction and eventual closure. Both indomethacin and ibuprofen are COX inhibitors with robust trial data showing high rates of PDA closure in preterm infants. Because of that evidence, either drug can be used as an effective pharmacologic option for a symptomatic PDA in an infant with respiratory distress syndrome. The choice in practice often depends on individual factors such as renal function, risk of NEC, and prior response, but overall they are considered similarly effective. If one agent isn’t suitable or fails, the other or surgical options may be pursued.