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We review relevant data aiming to define optimal early management strategies that promote early closure of ductus arteriosus without serious adverse effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Literature in English was searched selectively focusing on the potential of using acetaminophen for early closure of the ductus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Prophylactic ibuprofen or indomethacin intended to close the ductus, predisposes infants to ischaemia, bleeding and immune dysfunction. Acetaminophen appears to have a similar efficacy as indomethacin or ibuprofen, and all three dose\u2010dependently constrict the ductus. Ibuprofen and indomethacin cause non\u2010specific inhibition of prostaglandin synthesis, while acetaminophen predominantly inhibits prostaglandin E synthesis. Owing to low CYP450 activity in infancy, acetaminophen toxicity has been rarely evident. However, increasing the dosage increases the oxidative stress. We review prophylactic treatments that may increase the safety and efficacy of acetaminophen. These include vitamin A, cysteine and glutamine, and low\u2010dose corticosteroid supplementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The current challenge is to define a safe perinatal management practice that promotes cardiorespiratory adaptation in immature infants, particularly the seamless closure of the ductus before significant cardiopulmonary distress develops.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.15826","type":"journal-article","created":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T04:23:42Z","timestamp":1614745422000},"page":"1995-2007","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Early closure mechanisms of the ductus arteriosus in immature infants"],"prefix":"10.1111","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8172-729X","authenticated-orcid":false,"given":"Mikko","family":"Hallman","sequence":"first","affiliation":[{"name":"Department of Pediatrics Oulu University Hospital Oulu Finland"},{"name":"PEDEGO Research Unit Medical Research Center University of Oulu Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Marc","family":"Treluyer","sequence":"additional","affiliation":[{"name":"Facult\u00e9 de M\u00e9decine Universit\u00e9 de Paris Paris France"},{"name":"CIC\u20101419 Inserm Cochin\u2010Necker Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Outi","family":"Aikio","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Oulu University Hospital Oulu Finland"},{"name":"PEDEGO Research Unit Medical Research Center University of Oulu Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Christophe","family":"Roz\u00e9","sequence":"additional","affiliation":[{"name":"Department of Neonatology Nantes University Hospital Nantes France"},{"name":"Centre d'Investigation ClinIque CIC1413 INSERM Nantes University Hospital Nantes France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,21]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2011.09.022"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-4258"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2015.08.010"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2013.253"},{"key":"e_1_2_14_6_1","first-page":"CD003481","article-title":"Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants","volume":"2","author":"Ohlsson A","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"7","key":"e_1_2_14_7_1","first-page":"CD000174","article-title":"Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants","volume":"2010","author":"Fowlie PW","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-2051"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2017.03.021"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000499361"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197609022951003"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197609022951004"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(81)80479-9"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(80)80336-2"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)91304-1"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000480933"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-0359"},{"issue":"1","key":"e_1_2_14_18_1","first-page":"CD010061","article-title":"Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants","volume":"1","author":"Ohlsson A","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2020.01.058"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.1896"},{"key":"e_1_2_14_21_1","unstructured":"Roz\u00e9JC.Prophylactic treatment of the ductus arteriosus in preterm infants by acetaminophen (TREOCAPA).2020. 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