Abstract
Standard 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. We 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. 30 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. Paracetamol 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.
Highlights
Closure of ductus arteriosus after birth is very important for circulation adaptation to the extrauterine life
Between May 2015 and January 2017, there were a total of 30 preterm infants who had significant Patent ductus arteriosus (PDA). 11/30 received ibuprofen, and 3/30 had a spontaneous closure (10%) with gestational age (GA) 28, 28, and 29 weeks. 7 died (4 under ibuprofen treatment, two received no treatment, and one underwent PDA ligation), and nine patients received iv paracetamol (5 of them of ≤28 weeks of GA)
One patient was treated for 2 days due to an elevation in liver transaminases, but ductus was closed so treatment was discontinued
Summary
Closure of ductus arteriosus after birth is very important for circulation adaptation to the extrauterine life. Patent ductus arteriosus (PDA) in extremely premature infants is associated with morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia (BPD), and neurodevelopmental disabilities [1]. Standard medical treatment for PDA closure has been indometacin/ibuprofen or surgical ligation. Adverse events have been reported with NSAIDs [2], and surgical ligations have been associated with a higher incidence of BPD, retinopathy of prematurity, and neurodevelopmental disorders [3]. Many studies have reported similar efficiency of paracetamol to COX-inhibitors for closing PDA and less adverse events [5]. Standard medical treatment for patent ductus arteriosus (PDA) closure has been indomethacin/ibuprofen or surgical ligation. 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
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
