Paracetamol for Ductus Arteriosus Closure: Not Always a Success Story

Abstract

median birth weight: 700 g (min. 365, max. 950)] all received 60 mg/kg/day paracetamol for 3–8 days (i.v.: n = 9; oral: n = 1). Eight patients received ibuprofen [6 days (n = 6), 4 days (n = 1), 3 days (n = 1)] prior to paracetamol, and 2 patients received no ibuprofen. Paracetamol was started after a median postnatal age of 22 days (IQR: 13; min. 13, max. 30). One patient (10%) died after 7 days of paracetamol because of preexisting gastrointestinal problems before the ductus was reevaluated. In 2 patients (20%), no additional ductus treatment was needed (ductus closed in 1 patient, small insignificant ductus in 1 patient). These were the 2 patients that did not receive ibuprofen prior to paracetamol. In 7 patients (70%), paracetamol treatment failed and they needed surgical ligation. No elevations in ASAT and ALAT were found in our patients. Although the high paracetamol doses in the small groups of VLBW infants seem safe from a short-term perspective, further exploration is necessary [5] . The efficacy of paracetamol for PDA closure in our patients was dramatically lower compared to previously reported studies. A relatively old postnatal age in most of our patients might be important in explaining these differences in results. The role of paracetamol in PDA treatment during the first postnatal days needs further evaluation. Until eviDear Sir, We would like to respond to the article of Oncel et al. [1] entitled ‘Intravenous paracetamol treatment in the management of patent ductus arteriosus in extremely low birth weight infants’. They showed that high doses of intravenous paracetamol are effective for ductus arteriosus closure in preterm infants. In 2011, Hammerman et al. [2] first suggested that oral paracetamol would be a drug with high potential for neonatal ductus closure. Currently, there are 4 observational studies [1–4] that have included oral or intravenous paracetamol for patent ductus arteriosus (PDA). A total number of 29 neonates [median gestational age: 28+4 weeks (interquartile range [IQR]: 3); median weight: 925 g (IQR: 493); median postnatal age: 7 days (IQR: 6; min. 2, max. 27)] were included in those reports and showed an overall closure rate of 93% (27/29 patients) [5] . Guided by these promising reports, we implemented the use of paracetamol for PDA in very low birth weight (VLBW) neonates if ibuprofen therapy was contraindicated or if ibuprofen therapy had failed. Since December 2012, we have included 10 VLBW neonates with a hemodynamically significant PDA who received paracetamol because of a contraindication for ibuprofen (n = 4) or after ibuprofen failure (n = 6). The included patients [median gestational age: 25+1 weeks (min. 23+6, max. 26+6); Received: May 30, 2013 Accepted: June 4, 2013 Published online: July 31, 2013