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Conclusions Intravenous paracetamol was less effective in closing hsPDA than ibuprofen, but due to a similar constriction effect, its use was associated with the same hsPDA outcome. These results can support the use of i.v. paracetamol as a first-choice drug for the treatment of hsPDA.Trial registration Clinicaltrials.gov NCT02422966, Date of registration 04/09/2015; EudraCT no 2013-003883-30. What is Known • The successful closure of patent ductus arteriosus with oral paracetamol has been recently reported in several preterm infants,