A Retrospective Cohort Study to Evaluate the Use of Paracetamol Compared to Ibuprofen in the Medical Closure of Patent Ductus Arteriosus Among Preterm Infants in a Private Tertiary Hospital

Abstract

OBJECTIVE: To determine the effectiveness and safety of oral and intravenous paracetamol compared to oral ibuprofen in the closure of a patent ductus arteriosus (PDA) in preterm and/or low birth weight infants. METHODOLOGY: This was a retrospective cohort study involving 28 cases of premature and/or low birth weight infants at a private tertiary hospital from January 1, 2010 until June 30, 2014. Each patient received either oral paracetamol at a dose of 15 mg/kg every six hours for three days or oral ibuprofen at an initial dose of 10 mg/kg followed by 5 mg/kg at 24 and 48 hours. RESULTS: The PDA closure rates for both paracetamol and ibuprofen were identical at 64.3% (9/14). The mean days of closure for the paracetamol group was shorter at 1.5 ± 0.46 days in contrast to the ibuprofen group, which is 2.7 ± 0.48 days (p<0.001). There were no significant differences between the two groups in the incidence of adverse events. There were more preterm infants that had gastrointestinal bleeding in the ibuprofen group (28.6%) compared to the paracetamol group (7.1%) (p=0.326). Platelet counts in the ibuprofen decreased after one week of treatment at -87 + 115.84, while that of paracetamol group increased by 12 ± 92.34 (p=0.048). CONCLUSION: We have demonstrated that paracetamol has equivalent efficacy in the closure of PDA compared to ibuprofen, which is the standard drug for the medical treatment of PDA. Paracetamol, with its lower incidence of adverse events, may replace ibuprofen as a drug of choice in the treatment of PDA in preterm infants. KEYWORDS: preterms, PDA, paracetamol, closure, ibuprofen.