Intravenous Paracetamol for Patent Ductus Arteriosus in Premature Infants - A Lower Dose Is Also Effective

Tekgündüz, Kadir Şerafettin; Ceviz, Naci; Demirelli, Yaşar; Olgun, Haşim; Caner, İbrahim; Şahin, İrfan Oğuz; Yolcu, Canan

doi:10.1159/000348568

Cited by 33 publications

(28 citation statements)

References 12 publications

(8 reference statements)

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“…[12][13][14][15] We also found a significant difference of PDA diameter before and after the intervention. Based on this study and previous studies, intravenous paracetamol could be used as an alternative treatment for PDA closure in preterm infants, especially in cases contraindicated for ibuprofen and indomethacin.…”

Section: Discussionsupporting

confidence: 61%

“…[5][6][7][8][9][10][11][12][13][14][15] For case series using intravenous paracetamol, the proportion of successful PDA closure was between 75 and 100%.12-15 Our design was similar, but we had a larger sample size compared to previous case series. The proportion of successful PDA closure was lower at 65.5%, than in the four previous case series.…”

Section: Discussionmentioning

confidence: 99%

“…Ten cases had PDA closure, but 2 cases experienced reopening of the PDA. 15 In this study, intravenous paracetamol was given to subjects who could not be given enteral nutrition. In addition, intravenous preparations of ibuprofen and indomethacin were not yet available in Indonesia.…”

Section: Discussionmentioning

confidence: 99%

“…Paracetamol acts as a peroxidase inhibitor in prostaglandin synthesis. 4 In previous case series involving a limited number of subjects, both oral [5][6][7][8][9][10][11][12] and intravenous preparation [12][13][14][15] of paracetamol showed satisfactory results for PDA closure, with no liver toxicity. Moreover, two randomized, double-blind, control trials showed that oral paracetamol was better than oral ibuprofen.…”

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confidence: 88%

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Intravenous paracetamol and patent ductus arteriosus closure in preterm infants

Adriansyah

Idris

Djer

et al. 2017

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Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants. Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants. Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life. Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P<0.0001). Conclusion Intravenous paracetamol seems to be reasonably effective for PDA closure in preterm infants.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 88%

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Intravenous paracetamol and patent ductus arteriosus closure in preterm infants

Adriansyah

Idris

Djer

et al. 2017

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“…In contrast, our further case series demonstrated the opposite with treatment failure, and 2 of 3 infants developing elevated liver enzymes. Recently, Tekgunduz et al [4] also reported a significant increase in transaminase levels in an infant which normalized after paracetamol was discontinued. After this experience, the authors decided to decrease every dose of paracetamol to 10 mg/kg in their series.…”

Section: Tablementioning

confidence: 99%