Intravenous paracetamol with a lower dose is also effective for the treatment of patent ductus arteriosus in pre-term infants

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

doi:10.1017/s1047951114001577

Cited by 23 publications

(16 citation statements)

References 33 publications

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“…This result should be interpreted with caution considering the high proportion of subjects with GA >28 weeks treated with low doses 11 20…”

Section: Discussionmentioning

confidence: 92%

“…A transient increase in aspartate and alanine aminotransferases or γ-glutamyl transpeptidase was reported only in six patients enrolled in three of the 14 uncontrolled studies 12 16 20…”

Section: Resultsmentioning

confidence: 99%

“…This effect could be attributable to the ibuprofen albumin binding with consequent bilirubin displacement 34. A transient increase in aspartate and alanine aminotransferases or γ-glutamyl transpeptidase, without long-term consequences on liver function, has been reported in a small number of neonates receiving paracetamol 12 16 20. These events were observed only in patients receiving high doses of the drug.…”

Section: Discussionmentioning

confidence: 98%

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Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis

Terrin

Conte

Öncel

et al. 2015

Arch Dis Child Fetal Neonatal Ed

106

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“…This result should be interpreted with caution considering the high proportion of subjects with GA >28 weeks treated with low doses 11 20…”

Section: Discussionmentioning

confidence: 92%

“…A transient increase in aspartate and alanine aminotransferases or γ-glutamyl transpeptidase was reported only in six patients enrolled in three of the 14 uncontrolled studies 12 16 20…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis

Terrin

Conte

Öncel

et al. 2015

Arch Dis Child Fetal Neonatal Ed

106

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“…A report on high level of transaminases caused by iv paracetamol treatment for PDA closure in premature infants found that a lower dose of paracetamol also is effective ( 10 , 11 ). Therefore, the dose and dose interval of iv paracetamol treatment might require revision.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Paracetamol in Closure of Ductus Arteriosus in Infants under 32 Weeks of Gestation

et al. 2018

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BackgroundStandard medical treatment for patent ductus arteriosus (PDA) closure has been indomethacin/ibuprofen or surgical ligation. Up to date, new strategies have been reported with paracetamol. The aim of this study was to present our experience with intravenous paracetamol for closing PDA in preterm neonates presenting contraindication to ibuprofen or ibuprofen had failed and no candidates for surgical ligation because of huge instability.Materials and methodsWe conducted a retrospective case series study in a neonatal intensive care unit from a tertiary hospital. 9 preterm infants ≤32 weeks of gestational age with hemodynamically significant PDA (hsPDA) were enrolled. They received 15 mg/kg/6h intravenous paracetamol for ductal closure. Demographic data and transaminase levels before and after treatment were collected.Results30 preterm babies were diagnosed of hsPDA. 11/30 received ibuprofen with closure in 81.1%. 9 received intravenous paracetamol mainly due to bleeding disorders or thrombocytopenia. Successful closure on paracetamol was achieved in seven of nine babies (77.7%). There was a significant increase in transaminase levels in two patients. They required no treatment for normalization.ConclusionParacetamol is an effective option in closure PDA. It should be a first-line therapeutic option when there are contraindications for ibuprofen treatment. Transaminases must be checked during treatment.

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“…Four small case series have been performed by Tekgündüz et al [ 122 ], Memisoglu et al [ 118 ], Peňa-Juárez et al [ 123 ], and Tofé Valera et al [ 117 ] on 13, 11, 10, and 3 preterms, finding a hsPDA closure rate of 76.9%, 90,9%, 70%, and 100%, respectively, after paracetamol administration. Globally, hepatotoxicity (hypertransaminasemia) was described in two patients and no other significant side effects were detected.…”

Section: Discussion and Recent Literature Reviewmentioning

confidence: 99%

Paracetamol in Patent Ductus Arteriosus Treatment: Efficacious and Safe?

Bardanzellu

Neroni

Dessì

et al. 2017

BioMed Research International

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In preterm infants, failure or delay in spontaneous closure of Ductus Arteriosus (DA), resulting in the condition of Patent Ductus Arteriosus (PDA), represents a significant issue. A prolonged situation of PDA can be associated with several short- and long-term complications. Despite years of researches and clinical experience on PDA management, unresolved questions about the treatment and heterogeneity of clinical practices in different centers still remain, in particular regarding timing and modality of intervention. Nowadays, the most reasonable strategy seems to be reserving the treatment only to hemodynamically significant PDA. The first-line therapy is medical, and ibuprofen, related to several side effects especially in terms of nephrotoxicity, is the drug of choice. Administration of oral or intravenous paracetamol (acetaminophen) recently gained attention, appearing effective as traditional nonsteroidal anti-inflammatory drugs (NSAIDs) in PDA closure, with lower toxicity. The results of the studies analyzed in this review mostly support paracetamol efficacy in ductal closure, with inconstant low and transient elevation of liver enzymes as reported side effect. However, more studies are needed to confirm if this therapy shows a real safety profile and to evaluate its long-term outcomes, before considering paracetamol as first-choice drug in PDA treatment.

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Intravenous paracetamol with a lower dose is also effective for the treatment of patent ductus arteriosus in pre-term infants

Abstract: Intravenous paracetamol may be a useful treatment option for the treatment of patent ductus arteriosus in pre-term infants with contrindication to ibuprofen. In our experience, lower-dose paracetamol is effective in closing the patent ductus arteriosus in 83.3% of the cases.

Cited by 23 publications

References 33 publications

Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis

Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis

Efficacy of Paracetamol in Closure of Ductus Arteriosus in Infants under 32 Weeks of Gestation

Paracetamol in Patent Ductus Arteriosus Treatment: Efficacious and Safe?

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