Intravenous Paracetamol for Patent Ductus Arteriosus in Premature Infants - A Lower Dose Is Also Effective

Abstract

babies with hsPDA. The first patient was a 29-week premature infant (birth weight 1,045 g, postnatal age 3 days). Oral ibupro-fen was contraindicated in this patient due to suspected necrotizing enterocolitis (NEC). We started IV paracetamol with the dose regimen suggested by Oncel et al. [1] . After the first 4 doses, transaminase levels were checked and a significant increase was detected compared to pretreatment levels (aspartate aminotransferase (AST) 43 vs. 260 U/l, alanine aminotransferase (ALT) 11 vs. 180 U/l). The drug was ceased and transaminase levels normalized over the following 4 days. After this experience, we decreased each dose to 10 mg/kg (3 doses/day). An echocardiographic study was per-formed after each of the 3 doses. If the duc-tal shunt had disappeared, treatment was stopped, but if it persisted, an additional 3 doses were given, for a maximum of 4 days. In 6 additional patients, IV paracetamol was used with this dosing regimen. All were very low birth weight infants. The gesta-tional ages were <28 weeks (1 patient) and 28–31 weeks (5 patients). Oral ibuprofen could not be given to 2 patients due to Dear Sir, We read with great interest the recent article by Oncel et al. [1] entitled ‘Intrave-nous paracetamol treatment in the man-agement of patent ductus arteriosus in ex-tremely low birth weight infants’. It is the first study to report the results of intrave-nous (IV) paracetamol in premature in-fants where a 3-day treatment (15 mg/kg dose, 4 doses/day) is offered. In the case of treatment failure at the end of the third day, a second course is administered. Palmer et al. [2] reported the following dose regimen for IV acetaminophen to be safe in premature infants: 28–32 weeks, 10 mg/kg; 32–36 weeks, 12.5 mg/kg, and 36 weeks, 15 mg/kg. Although the gestational ages of the patients in the study of Oncel et al. [1] were low, they used a higher dose; no side effect related to IV paracetamol was re-ported. In our clinical practice, prematures with hemodynamically significant patent ductus arteriosus (hsPDA) and contraindi-cations for oral ibuprofen present a great challenge. For these patients, IV para ce ta-mol seems to be a good alternative. We ad-ministered IV paracetamol in 7 preterm