Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials

Huang, Xintao; Wang, Fang; Wang, Kai

doi:10.1080/14767058.2017.1338263

Cited by 29 publications

(22 citation statements)

References 26 publications

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“…A recent Cochrane systematic review demonstrated no difference in efficacy between oral paracetamol and oral ibuprofen (35). As the same two RCTs (28). In our research, the comparison of paracetamol and ibuprofen identified nine studies that reported primary closure and 10 studies that reported total closure.…”

Section: Discussionsupporting

confidence: 69%

“…In the first search, of the 23 systematic reviews and 129 citations retrieved, four systematic reviews (27)(28)(29)32) were assessed to extract RCTs or quasi-RCTs ( Table 3). The full texts of 10 articles (2, 13, 14, 21-25, 36, 37) that met the inclusion criteria were assessed for eligibility after retrieval of the RCTs or quasi-RCTs (Figure 1).…”

Section: Description Of Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Xiao

Liu

et al. 2020

Front. Pediatr.

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Section: Discussionsupporting

confidence: 69%

Section: Description Of Studiesmentioning

confidence: 99%

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Xiao

Liu

et al. 2020

Front. Pediatr.

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“…[9] A meta-analysis showed that paracetamol may confer treatment efficacy for closure of PDA comparable to that of ibuprofen with a lower risk of adverse events. [10] However, several studies have shown varied results. [11] Some studies demonstrated a lower PDA closure rate with paracetamol compared to ibuprofen.…”

Section: Introductionmentioning

confidence: 99%

Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

Lu¹,

Li²,

Lin³

et al. 2019

Medicine

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Paracetamol (acetaminophen) has been proposed as an alternative medication for closing hemodynamically significant patent ductus arteriosus (PDA). However, the clinical outcomes remain inconclusive in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. The aim of this study was to compare the efficacy and safety of oral paracetamol and ibuprofen for pharmacological closure of PDA in premature infants from a real-world study. This retrospective study enrolled 255 preterm infants with birthweights of ≤1.5 kg, and echocardiographically confirmed significant PDA. Subjects were classified into 3 groups: Group I (standard-dose ibuprofen group) received 10 mg/kg oral ibuprofen followed by 5 mg/kg/day for 2 days. Group II (high-dose ibuprofen group) received 10 mg/kg/day oral ibuprofen for 3 days. Group III (paracetamol group) received 15 mg/kg/6 h oral paracetamol for 3 days. On day 9 after medication start, PDA closure was achieved in 61 (71.7%) patients assigned to the high-dose ibuprofen group, (63.8%) in the standard-dose ibuprofen group, and 33 (37.9%) of those in the oral paracetamol group ( P <.001). Oral standard-dose ibuprofen was more effective than oral paracetamol ( P = .001). The ductus closed faster in the high-dose ibuprofen group than in the standard-dose group (median closure time 3.9 ± 1.0 versus 4.4 ± 1.0 days, P = .009). Total bilirubin significantly increased in the high-dose ibuprofen group ( P = .02). No gastrointestinal, renal, or hematological adverse effects were reported. Subgroup analyses indicated paracetamol was minimally effective in ELBW infants (PDA closure 13%). This study demonstrated that paracetamol may be a poor medical alternative for PDA management in VLBW and ELBW infants. High dosage ibuprofen was associated with a faster clinical improvement and higher rate of PDA closure.

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“…In 2018, Huang et al (33), published a systematic review of five RCTs including a total of 677 neonates treated with either paracetamol or ibuprofen. The rates of primary and overall PDA closure were similar between treatments (RR 1.03, p = 0.56 and RR 1.02, p = 0.62 for paracetamol and ibuprofen, respectively).…”

Section: Introductionmentioning

confidence: 99%

Paracetamol vs. Ibuprofen in Preterm Infants With Hemodynamically Significant Patent Ductus Arteriosus: A Non-inferiority Randomized Clinical Trial Protocol

et al. 2020

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This is a non-inferiority, randomized, multicenter, double-blinded study to evaluate the efficacy, and safety of intravenous (IV) paracetamol vs. IV ibuprofen (standard treatment) for PDA in preterm patients with a gestational age ≤30 weeks. At baseline, patients will be randomized (1:1) to treatment with paracetamol or ibuprofen. The primary endpoint is closure of the ductus after the first treatment course. Secondary endpoints are related to effectiveness (need for a second treatment course, rescue treatment, reopening rate, time to definitive closure, need for surgical ligation), safety (early and long-term complications), pharmacokinetics, and pharmacodynamics, pharmacogenetics, pharmacoeconomics, and genotoxicity. Long-term follow-up to 24 months of corrected postnatal age will be performed using Bayley III neurodevelopmental scale.

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Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials

Abstract: Paracetamol may confer comparable treatment efficacy for the closure of PDA as ibuprofen, although paracetamol is associated with lower risk of adverse events.

Cited by 29 publications

References 26 publications

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

Paracetamol vs. Ibuprofen in Preterm Infants With Hemodynamically Significant Patent Ductus Arteriosus: A Non-inferiority Randomized Clinical Trial Protocol

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