Abstract Body (Do not enter title and authors here): Introduction
Ibuprofen is used to induce closure of patent ductus arteriosus (PDA) in preterm infants due to its fewer side effects compared to other nonsteroidal anti-inflammatory drugs. However, ibuprofen treatment has not improved survival or decreased morbidity in this population.

Objective
To compare expectant management vs. ibuprofen treatment in preterm infants with PDA.

Methods
We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing expectant management versus treatment with ibuprofen in preterm infants with PDA. Outcomes of interest included all-cause mortality, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), sepsis, surgical or transcatheter PDA ligation, cystic periventricular leukomalacia (CPL), pulmonary hemorrhage, impaired renal function, composite outcome of BPD or death, duration of ventilator support and duration of supplemental oxygen therapy. Random effects models were used to generate risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Analysis followed the PRISMA guideline.

Results
The meta-analysis consisted of 5 randomized controlled trials including 1,536 infants. All-cause mortality, BPD, NEC, IVH, ROP, sepsis, PDA ligation, pulmonary hemorrhage, composite of BPD or death, duration of ventilator support and duration of supplemental oxygen therapy did not show any significant differences between the groups. CPL (RR 0.50; 95%CI 0.27-0.92; p=0.02) and impaired renal function (RR 0.64; 95%CI 0.51-0.81; p<0.001) were significantly lower with expectant management.

Conclusion
In preterm infants with PDA, expectant management did not show any difference in all-cause mortality and adverse clinical outcomes compared with ibuprofen treatment. However, there was a lower risk of CPL and impaired renal function with expectant management.