***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND Indomethacin is the conventional treatment for hemodynamically important patent ductus arteriosus in preterm infants . However , its use is associated with various side effects . In a prospect i ve study , we compared ibuprofen and indomethacin with regard to efficacy and safety for the early treatment of patent ductus arteriosus in preterm infants . METHODS We studied 148 infants ( gestational age , 24 to 32 weeks ) who had the respiratory distress syndrome and an echocardiographically confirmed , hemodynamically important patent ductus arteriosus . The infants were r and omly assigned at five neonatal intensive care centers to receive three intravenous doses of either indomethacin ( 0.2 mg per kilogram of body weight , given at 12-hour intervals ) or ibuprofen ( a first dose of 10 mg per kilogram , followed at 24-hour intervals by two doses of 5 mq per kilogram each ) , starting on the third day of life . The rate of ductal closure , the need for additional treatment , side effects , complications , and the infants ' clinical course were recorded . RESULTS The rate of ductal closure was similar with the two treatments : ductal closure occurred in 49 of 74 infants given indomethacin ( 66 percent ) , and in 52 of 74 given ibuprofen ( 70 percent ) ( relative risk , 0.94 ; 95 percent confidence interval , 0.76 to 1.17 ; P=0.41 ) . The numbers of infants who needed a second pharmacologic treatment or surgical ductal ligation did not differ significantly between the two groups . Oliguria occurred in 5 infants treated with ibuprofen and in 14 treated with indomethacin ( P=0.03 ) . There were no significant differences with respect to other side effects or complications . CONCLUSIONS Ibuprofen therapy on the third day of life is as efficacious as indomethacin for the treatment of patent ductus arteriosus in preterm infants with the respiratory distress syndrome and is significantly less likely to induce oliguria A controlled , double blind trial of indomethacin versus placebo was conducted in prematures of birth weight < 1750 g , with a murmur of patent ductus arteriosus ( PDA ) . The dose of indomethacin was 0.2 mg/kg for 2 doses , orally , 24 hours apart . Forty-seven patients entered the trial . Twenty-four received indomethacin and 12 of these met the criteria for response ; 23 received the placebo and two met the criteria for response ( p < 0.01 ) . Subsequent surgical ligation for symptomatic PDA was required in 13 of 23 in the placebo group and 4 of 24 in the indomethacin group ( p < 0.01 ) . When administered early , indomethacin is moderately effective in closing PDA in premature infants A prospect i ve r and omized controlled trial was performed to compare the effects of ibuprofen with indomethacin on cerebral hemodynamics measured using near infrared spectroscopy in preterm infants during treatment for patent ductus arteriosus . Infants were r and omly assigned to three intravenous doses of either indomethacin ( 0.20–0.25 mg/kg , 12 hourly ) or ibuprofen ( 5–10 mg/kg , 24 hourly ) and also received a dose of saline . The primary end points of the study were the effects of the first dose on cerebral blood flow ( CBF ) and cerebral blood volume . Fifteen infants received indomethacin and 18 received ibuprofen .  The group mean ( SD ) values for CBF ( mL·100 g−1·min−1 ) before and after the first dose of indomethacin were 13.6 ( 4.1 ) and 8.3 ( 3.1 ) , respectively , the change being significant ( p < 0.001 ) . In contrast , no significant changes in CBF were observed with the first dose of ibuprofen , the respective before and after values being 13.3 ( 3.2 ) and 14.9 ( 4.7 ) mL·100 g−1·min−1 . The median ( interquartile range ) value for change in cerebral blood volume ( mL/100 g ) after the first dose in the indomethacin group was −0.4 ( −0.3 to −0.6 ) and in the ibuprofen group was 0.0 ( 0.1 to −0.1 ) , the difference between the two groups being significant ( p < 0.001 ) . Cerebral oxygen delivery changed significantly after the first dose in the indomethacin group but not in the ibuprofen group . Significant reductions in CBF , cerebral blood volume , and cerebral oxygen delivery also occurred after the 24-h dose of indomethacin , but there were no significant changes after the 48-h dose of saline in the indomethacin group or after the 24- and 48-h doses of ibuprofen . The patent ductus arteriosus closure rates after indomethacin and ibuprofen were 93 and 78 % , respectively . We conclude that ibuprofen , unlike indomethacin , has no adverse effects on cerebral hemodynamics and appears to mediate patent ductus arteriosus closure 23 premature infants were placed on a r and omized double-blind study to evaluate the effectiveness of indomethacin in closing a patent ductus arteriosus . Infants received 0.2 mg/kg indomethacin or placebo by gavage . In the treatment group , 7 patients responded out of a total of 12 , while in the placebo group , 2 responded out of a total of 11 .  Indomethacin plasma levels were obtained in 6 patients in the treatment group . Plasma levels showed marked variability in peak level ( 60 - 3,100 ng/ml ) , time to peak level ( 0.5 - 6 h ) and t1/2 ( 1 to greater than 24 h ) Prophylactic closure of the patent ductus arteriosus ( PDA ) has been recommended as a means of decreasing early respiratory distress , and thereby chronic respiratory sequelae in the very low birth weight ( VLBW ) neonate . This study was undertaken to evaluate some possible mechanisms for the observed failure of early indomethacin therapy to achieve such improvement . 24 VLBW infants with echocardiographic evidence of PDA were r and omized to receive either indomethacin or placebo at 48 h of life ; and then they were studied for clinical , metabolic and laboratory signs of ductal constriction and /or reopening . Early indomethacin conferred no improvement in respiratory sequelae . However , this was not secondary to a short-term therapeutic failure . Prophylactic indomethacin , even in the VLBW infant , was successful in decreasing dilator prostagl and in production , and probably in closing the PDA and in decreasing the number of recurrences . The implication s are that even with effective ductal constriction , overall morbidity is not affected As a result of r and omized assignment , 15 preterm infants weighing 1,500 gm or less at birth and who had a symptomatic PDA were treated according to a medical management protocol , and ten according to an early surgical closure protocol .  All infants required  mechanical ventilation  at the time of study entry , which was one week after birth . Birth weight , gestational age , age at onset of congestive failure , age at study entry , and the initial morbidity of members of the two groups were similar . The nine surviving infants managed according to the surgical closure protocol were weaned from mechanical ventilation sooner , had a decreased need for digoxin and furosemide , achieved gastrointestinal function sooner , and had a smaller hospital bill than the 12 survivors of the medical management group . These results indicate that infants with a symptomatic PDA still requiring mechanical ventilation  at one week after birth will benefit from surgical closure of the ductus at that time OBJECTIVE To compare efficacy and side effects of early versus late indomethacin treatment for patent ductus arteriosus ( PDA ) in premature infants . METHODS One hundred twenty-seven neonates receiving ventilatory assistance ( gestational age : 26 - 31 weeks ) with PDA confirmed by echocardiography were r and omly assigned in a prospect i ve multicenter trial to either early ( day 3 , n = 64 ) or late ( day 7 , n = 63 ) intravenous indomethacin treatment ( 3 x 0.2 mg/kg every 12 hours ) . Treatment history and side effects were registered . RESULTS The PDA closure rate was higher in the early treatment group at both 6 ( 73 % vs 44 % , P = .0008 ) and 9 days of age ( 91 % vs 78 % , P = .047 ) . However , there was no significant difference in PDA ligation . Urine output was significantly lower ( P < .0001 ) , serum creatinine level was higher ( P = .016 ) , and more indomethacin courses were administered in the early treatment group ( 70 vs 26 ) . Respiratory support , number of deaths , and intraventricular hemorrhages were similar in both groups . However , on the whole , major adverse events ( death , necrotizing enterocolitis , and /or localized perforation , extension of hemorrhage , or cystic leukomalacia ) occurred more frequently in the early treatment group ( P = .017 ) . CONCLUSION Early indomethacin treatment improves PDA closure but is associated with increased renal side effects and more severe complications and has no respiratory advantage over late indomethacin administration in ventilated , surfactant-treated , preterm infants < 32 weeks ' gestational age To evaluate the effects on cerebral and renal blood flow velocities of ibuprofen when used as prophylaxis for patent ductus arteriosus in preterm neonates ( gestational age ≤30 weeks ) A controlled clinical trial comparing early closure ( mean = 48.8 hours ) of the patent ductus arteriosus using indomethacin to conventional medical management , with intervention only after cardiopulmonary decompensation ( mean = 167.4 hours ) , was undertaken in 24 preterm infants with severe respiratory distress syndrome and evidence of PDA . An interval analysis of one-half the projected sample revealed that infants undergoing early closure of the PDA had significantly reduced occurrence of BPD or mortality by 6 months of age . A comparison of birth weight , Apgar scores , gestational age , age of initial PDA diagnosis , and fluid therapy during the first seven days of life showed no significant differences between early intervention and control groups . At the time of the interval analysis , there were no differences between the groups in duration of intermittent m and atory ventilation or oxygen exposure . Studies will be required to determine whether these and other variables can be altered by early closure of the PDA ABSTRACT . Thirty‐seven preterm infants with idiopathic respiratory distress syndrome were prospect ively studied for the effect of the early closure of patent ductus arteriosus with indomethacin on the course of idiopathic respiratory distress syndrome . Serial retro grade aortograms were performed in all infants in order to visualize the ductus arteriosus , apart from three patients , who died early and were evaluated aortographically only once . The ductus was initially open in 27 infants and closed in 10 infants . The infants with open ductus arteriosus were r and omly divided into two groups . The first group consisted of 13 infants , in whom the ductus was closed with indomethacin at a median age of 18 hours . The other 14 infants served as controls . Total time on assisted ventilation and duration of exposure to additional oxygen were significantly shorter in medicated infants than in controls . Oxygenation of infants with an initially closed ductus was better from birth and duration of their ventilatory assistance and oxygen exposure were shorter than in infants with initial ductal shunting . The data suggest that the early closure of the patent ductus arteriosus with indomethacin in distressed preterm infants has a favourable effect on the course of idiopathic respiratory distress syndrome Early treatment of premature infants with  indomethacin has been proposed as a means of reducing the morbidity associated with respiratory distress syndrome complicated by symptomatic patent ductus arteriosus . We identified 26 infants less than 48 hours old with severe respiratory distress syndrome who had an asymptomatic patent ductus arteriosus . These infants were treated with either indomethacin or placebo . There was a significant difference in the frequency of ductal closure after receiving indomethacin treatment . No significant difference was observed in the time required for mechanical ventilation , time receiving supplemental oxygen , or time in the hospital , and there were no significant differences in the incidence of bronchopulmonary dysplasia , intraventricular hemorrhage , retinopathy of prematurity , or death between the two groups We performed a double-blind , controlled study of prophylactic indomethacin therapy in 47 premature infants ( less than 1700 g ) who had sub clinical patent ductus arteriosus . They received either indomethacin or placebo at a mean age of 2.9 days . Among the 25 infants weighing more than 1000 g , a hemodynamically important ductus shunt developed in only four of the 14 given placebo . The incidence of important sh 
    Output:
    
REVIEW ER 'S CONCLUSIONS This review demonstrates a significant decrease in the incidence of symptomatic PDA following treatment of an asymptomatic PDA with indomethacin .
There is also a small but statistically significant decrease in the duration of requirement for supplemental oxygen .