Oral Paracetamol for Patent Ductus Arteriosus Rescue Closure

Abstract

The objective of this study was to ascertain the efficacy of oral paracetamol in closing a symptomatic patent ductus arteriosus (PDA) when used as 'rescue' option. After obtaining ethics approval, a retrospective appraisal of the data from April 2014 to July 2015 was performed. Infants who were administered oral paracetamol either after unsuccessful therapy with ibuprofen or where it was considered contraindicated were included. A previously published echocardiographic scoring schema to stratify for ductal disease severity was used. Using univariate analysis, characteristics of infants with successful closure were compared with partial (a priori reduction in composite score by ≥ 50% of pretreatment) or no closure. Twenty infants with gestation age and birthweight of 25.7 ± 1.5 weeks and 724.1 ± 143 g, respectively, were studied. Complete closure was noted in 10 (50%) infants with additional four infants showing a significant reduction in haemodynamic shunting. Gestational age at birth and at therapy, chronological age at therapy, birthweight and total fluid intake were comparable between the two groups. The pre-therapy composite score had a significant association with successful closure (the higher the echocardiographic score, the lesser the closure). Concomitant furosemide therapy and late-onset sepsis had a high likelihood ratio of unsuccessful closure (11.01 [2-tailed, p = 0.005] and 5.3 [2-tailed, p = 0.07]), respectively. Oral paracetamol may be a possible therapeutic option in premature infants where therapy with first-line agents is unsuccessful or contraindicated. Concomitant sepsis and furosemide administration may affect successful therapy.

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

“…Some literature recommends 5 to 7 days or more of paracetamol treatment for PDA, while other literatures recommend only a 3 days course, similar to the administration strategy for ibuprofen. [46,47] This may explain the low closure rate seen with paracetamol treatment in our study. However, no significant research studies show better efficacy with a 7 days treatment compared to a 3 days treatment.…”

Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

“…The diagnosis of hemodynamically significant ductal patency requires echocardiographic assessment. However, the definition of hemodynamically significant patent ductus arteriosus remains controversial [19].…”

Adding Paracetamol to Ibuprofen for the Treatment of Patent Ductus Arteriosus in Preterm Infants: A Double-Blind, Randomized, Placebo-Controlled Pilot Study

“…[5][6][7] Furthermore, in different studies, the PDA closure rate of paracetamol was very variable, ranging between 20 and 100%. 5,[23][24][25][26][27] So far, the combination of NSAID and paracetamol has not been studied in preterm infants. In the pediatric population, no adverse effects or precautions were attributed to the combination of the two medications.…”