An interesting observation of PDA closure with oral paracetamol in preterm neonates

Abstract

Patent ductus arteriosus (PDA), in which there is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus, is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with either Indomethacin or Brufen which are cyclooxygenase 1, 2 inhibitor; however these drugs are associated with side effects. We report an interesting findings of ductal closure in 10 preterm neonates (gestational age 27-33 wks) presenting with significant large PDA who had failed or had absolute contraindication with Brufen. These preterm neonates were treated with oral paracetamol in the dose of 15 mg/kg 8 hourly. The PDA closure was achieved within 48 h and there was no complication.

Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis

“…This result should be interpreted with caution considering the high proportion of subjects with GA >28 weeks treated with low doses 11 20…”

Acetaminophen for Patent Ductus Arteriosus

“…The case reports explored the use of enteral and IV-administered acetaminophen when traditional ibuprofen or indomethacin therapy had failed or was contraindicated. [15][16][17][18][19][20][21][22][23][24][25][26] The 2 controlled trials compared off-label use of oral acetaminophen and oral ibuprofen for PDA treatment. Previous trials have demonstrated that oral ibuprofen has efficacy equivalent to that of the IV formulation when an identical dosing regimen is used.…”

Intravenous paracetamol and patent ductus arteriosus closure in preterm infants

“…[5][6][7][8][9][10][11][12][13][14][15] For case series using intravenous paracetamol, the proportion of successful PDA closure was between 75 and 100%.12-15 Our design was similar, but we had a larger sample size compared to previous case series. The proportion of successful PDA closure was lower at 65.5%, than in the four previous case series.…”

“…Paracetamol acts as a peroxidase inhibitor in prostaglandin synthesis. 4 In previous case series involving a limited number of subjects, both oral [5][6][7][8][9][10][11][12] and intravenous preparation [12][13][14][15] of paracetamol showed satisfactory results for PDA closure, with no liver toxicity. Moreover, two randomized, double-blind, control trials showed that oral paracetamol was better than oral ibuprofen.…”