C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series

Abstract

Abstract Background Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention. Case Summary We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (<36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (>42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%. Discussion Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.