OBJECTIVEPatent ductus arteriosus (PDA) is common in premature neonates. The use and selection of pharmacologic therapy are controversial because of unclear long-term benefits and the potential of adverse effects. The objective of this review was to explore the safety and efficacy for indomethacin, ibuprofen, and acetaminophen for PDA management.METHODSA chart review was conducted for neonates who received pharmacologic treatment for PDA at our institution between July 1, 2016, and May 30, 2023. Data collected included treatment success or failure; adverse reactions to the medications, including renal dysfunction, gastrointestinal perforation or bleeding, hepatotoxicity, and/or death; and complications, including bronchopulmonary dysplasia, pulmonary hypertension, surgical closure, and death before discharge.RESULTSA total of 91 neonates met the inclusion criteria. The efficacy rates for the first treatment course were 25 of 31 (80.6%) for indomethacin, 4 of 16 (25%) for ibuprofen, and 27 of 44 (61.4%) for acetaminophen. Complications occurred in 12 of 31 (38.7%) for indomethacin, 9 of 16 (56.3%) for ibuprofen, and 0 of 44 (0%) for acetaminophen.CONCLUSIONIndomethacin and acetaminophen had good efficacy, though indomethacin had a high incidence of complications. Ibuprofen had lower efficacy than expected (25%) and concerning safety outcomes, which requires further investigation to see if ethnicity plays a role.