Ductal closure with intravenous paracetamol: a new approach to patent ductus arteriosus treatment

Abstract

Objectives: Indomethacin and ibuprofen are commonly used in the treatment of hemodynamically significant patent ductus arteriosus (hsPDA). These drugs are associated with serious adverse events, including gastrointestinal perforation, renal failure and bleeding. The role of paracetamol has been proposed for the treatment of PDA.Methods: We report a series of 11 neonates (birth weight: 415-1580g; gestational age: 23-30.3 weeks) who were treated with paracetamol for a hsPDA. Neonates with hsPDA were treated with paracetamol in the presence of contraindications to ibuprofen or indomethacin. The condition of significant PDA was defined by the presence of at least one of the following criteria: internal ductal diameter # 1.4mm/kg body weight, left atrium (LA)-to-aortic (Ao) root ratio >1.4, unrestrictive pulsatile transductal flow, reverse or absent diastolic flow in the descending aorta along with clinical findings. Intravenous (IV) paracetamol was given at doses 15mg/kg every 6h for three days.Results: Successful ductal closure was achieved in 10 out of 11 babies (90.9%). No adverse or side effects were observed during the treatment.Conclusions: On the basis of these results, paracetamol could be considered as a promising and safe therapy for the treatment of PDA in preterm infants.