Abstract
Persistent patent ductus arteriosus (PDA) is associated with significant co-morbidities and increased mortality in preterm infants, especially very low birth weight (VLBW) infants. A large number of studies on the management of PDA have been published. Despite PDA being such a common condition in preterm infants, there is no consensus on which PDAs to treat, when to treat and how best to treat. Nonspecific cyclo-oxygenase inhibitors such as indomethacin and ibuprofen have been the mainstay of medical treatment of PDA for decades. Ibuprofen has similar efficacy and higher safety profile when compared to indomethacin, as it is associated with fewer gastrointestinal and renal side effects, and is considered the drug of choice for PDA closure. Recently, there is a growing interest in paracetamol for PDA closure and it has been suggested as an alternative drug to treat PDA. Finding the optimal pharmacological treatment for PDA closure in VLBW continues to remain challenging. In this review article, we assessed the evidence of paracetamol for PDA closure VLBW infants.
Highlights
The ductus arteriosus remains persistent in up to 60% of preterm infants and its incidence is inversely related to birth weight and gestational age (GA) [1]
Despite being such a common problem in preterm infants and its strong association with increased mortality and severe co-morbidities, there is no consensus on the treatment of patent ductus arteriosus (PDA) - which PDAs to treat, when to treat and how best to treat? The treatment options for PDA closure are: pharmacological therapy or surgical ligation
We reviewed the literature and have attempted to evaluate the role of paracetamol in PDA closure in preterm infants
Summary
The ductus arteriosus remains persistent in up to 60% of preterm infants and its incidence is inversely related to birth weight and gestational age (GA) [1]. A recent observational study by Sellmer et al [5] reported that a large PDA (>1.5 mm) on day 3 after birth was associated with threefold increase in odds of death or severe morbidity (OR of IVH 4.2 whilst OR of chronic lung disease was 3.7). Despite being such a common problem in preterm infants and its strong association with increased mortality and severe co-morbidities, there is no consensus on the treatment of PDA - which PDAs to treat, when to treat and how best to treat? A recent Cochrane meta-analysis reported that paracetamol appears to be a promising alternative to ibuprofen and indomethacin for the PDA closure [19] It recommended additional studies on its efficacy, safety. We reviewed the literature and have attempted to evaluate the role of paracetamol in PDA closure in preterm infants
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