Abstract
Inhibitors of the cyclo-oxygenase component of prostaglandin-H2 synthetase, namely indomethacin and ibuprofen, are commonly used in the treatment of hemodynamically significant patent ductus arteriosus. These drugs are associated with serious adverse events, including gastrointestinal perforation, renal failure and bleeding. The role of paracetamol, an inhibitor of the peroxidase component of prostaglandin-H2 synthetase, has been proposed for the treatment of patent ductus arteriosus. We report a series of 8 neonates (birth weight: 724 ± 173 g; gestational age: 26 ± 2 weeks) treated with paracetamol for a hemodynamically significant patent ductus arteriosus, because of contraindications to ibuprofen or indomethacin. Successful closure was achieved in 6 out of 8 babies (75%). Median ductal diameter was significantly reduced after treatment (from 1.2 mm, range 1.0-2.5 mm to 0.6 mm, range 0.0-2.5 mm, p = 0.038). No adverse or side effects were observed during treatment. On the basis of these results, paracetamol could be considered a promising and safe therapy for the treatment of patent ductus arteriosus in neonates.
Highlights
A persistently patent ductus arteriosus (PDA) has significant clinical consequences in preterm neonates during the recovery period from respiratory distress syndrome [1]
Despite the about 70% success rate, COX-inhibitors are frequently contraindicated in early life and their use has been associated with serious adverse events, such as gastrointestinal perforation, renal failure and bleeding [4,5,6,7,8,9,10,11]
Case presentation We report a case series of neonates with hs-PDA treated with paracetamol because of contraindication to ibuprofen or indomethacin, who were observed at the Neonatal Intensive Care Unit of the University of Rome “Sapienza”, from January 2012 to October 2013
Summary
A persistently patent ductus arteriosus (PDA) has significant clinical consequences in preterm neonates during the recovery period from respiratory distress syndrome [1]. Case presentation We report a case series of neonates with hs-PDA treated with paracetamol because of contraindication to ibuprofen or indomethacin, who were observed at the Neonatal Intensive Care Unit of the University of Rome “Sapienza”, from January 2012 to October 2013. Efficacy was defined by the rate of patients in whom we observed ductal closure (defined by the absence of shunt or diameter < 0.5 mm without any other hemodynamic implications) at echocardiographic examination performed daily during the study period. The two patients in whom paracetamol failed to close the ductus, intravenous ibuprofen (at a dose of 10 mg/kg followed by 5 mg/kg after 24 and 48 hours) was given considering that previous contraindications were no longer present. One of the 2 patients who failed treatment with paracetamol developed bronchopulmonary dysplasia
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