Use of intravenous paracetamol for patent ductus arteriosus closure in preterm and very low birth infants

Abstract

The patent ductus arteriosus contributes to common morbidities in premature infants.Ductal closure may require pharmocological management and/or surgical ligation up to 70% of time in extremely low birth infants. Ductal closure utilising NSAIDs has many adverse effects related to their vasoconstrictive effects on renal cerebral and mesentric vessels. While NSAIDS are known to inhibit COX activity via Arachidonic acid pathway, acetaminophen inhibits peroxidase activity. It seems to be a reasonable optionto consider for PDA closure, especially in those infants for which NSAIDSmay be contraindicated. Place of study: A prospective study in Neonatal intensive care unit 1. Maternity and childrens hospital. Makkah. Patients: preterms and extreme preterms-24–30 weeks, Birth weight 450 g-1.2 Kg with haemodynamically significant PDA. iNTERVENTION: iv PARACETAMOL −15 MG/kG/dose Q 6 hrly × 3–5 days with parenteal consent. 1. Total no: of admissions in NICU-1 1150. For 20 months from 8/1437 to 3/39. 2. 100 patients had haemodynamically significant PDA where NSAIDs were contraindicated. 3 24-26 wks 20 27–29 wks 50 30–32 wks 30 4. weight wise distribution. <1 kg 1–1.5 Kg 1.5–2 kg. 45 52 3 5 male: female. M 53 F 47 1. −32% had PNA. 2–13% had CPR at birth. 3 −40% had IVH of which 11% had gradeIII-iv IVH. 4. −35% had pulmonary haemorrhage. 5 −13% had pneumothorax. 6. −61% had CLD. 7. −86% had hypotension 8. – 100% were NPO. 9. All had central line. 10. 90% had renal impairment. 11–95% had electrolyte imbalance either before or after treatment. 12 49% had +ve blood culture. 13. thrombocytopenia was noticed in 50% of them. 14 80% were discharged home 20% expired. PDA: echo first done: 1–7 days. 80% 2nd/3rd day. Duration of paracetamol: 3–5 days. Effective closure after 1st dose-44%. Effective closure after 2nd course of paracetamol-21%. NSAIDS used after paracetamol in 10%. Hydrochlorthiazide used in 8%. PDA reopened due to sepsis-7%. Intravenous paracetamol can be safely used in extreme low birth infants.