Original title: PDA Closure Rates and Safety after Repeated Courses of Cyclooxygenase Inhibitors in Preterm Infants: A Systematic Review and Meta-Analysis
Junichi Saito, Yuka Sano Wada, Kota Yoneda, Kunio Ogawa +3 · September 2026
Before birth, babies have an open blood vessel near the heart called the patent ductus arteriosus, or PDA. In preterm infants, this vessel sometimes stays open and strains blood flow. Doctors treat it with drugs called cyclooxygenase inhibitors to close the opening. If the vessel stays open after one round of drugs, doctors must decide whether to give more rounds or do surgery. Researchers reviewed 33 studies to see how well repeat rounds work. The drugs close the vessel, but each extra round works less well than the one before it. The closure rate was 62% after the first course. It dropped to 46% after the second course, and fell to 38% after the third course. These lower closure rates also showed up in most infant subgroups. The researchers also looked for safety issues, but there was limited data on side effects to study.
You're trying to seal a small leak in a bicycle tire with a patch. The first patch usually fixes it. But if the leak persists, putting another patch over the same spot is less likely to hold because the rubber is already stretched and worn. In this paper, the leak is the open blood vessel in a preterm baby's heart, and the patch is the drug course.
Doctors often give multiple rounds of a drug to close a heart duct that stays open in preterm babies. This study shows that with each extra round, the drug is less likely to work. That helps doctors decide when to switch to other treatments, but we still don't know enough about the risks of repeated doses.
The abstract notes that data on adverse events were too limited to analyze safety. It also says that the lower closure rate for the second course was not seen for oral administration, suggesting the finding may not apply in all cases. The review is based on 33 studies of various designs, and the results might be affected by differences in the populations and methods.
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PDA Closure Rates and Safety after Repeated Courses of Cyclooxygenase Inhibitors in Preterm Infants: A Systematic Review and Meta-Analysis — Junichi Saito, Yuka Sano Wada, Kota Yoneda et al. — medRxiv — doi:10.64898/2026.09.09.26360534
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper. This is a preprint, so it hasn't necessarily been peer reviewed.