Limited effects of intravenous paracetamol on patent ductus arteriosus in very low birth weight infants with contraindications for ibuprofen or after ibuprofen failure.

Abstract

UNLABELLED:

Finding the optimal pharmacological treatment of a patent ductus arteriosus (PDA) in preterm neonates remains challenging. There is a growing interest in paracetamol as a new drug for PDA closure. In this prospective observational cohort study, we evaluated the effectiveness of intravenous paracetamol in closing a PDA in very low birth weight infants with a hemodynamically significant PDA who either did not respond to ibuprofen or had a contraindication for ibuprofen. They received high-dose paracetamol therapy (15 mg/kg/6 h intravenous) for 3-7 days. Cardiac ultrasounds were performed before and 3 and 7 days after treatment. Thirty-three patients were included with a median gestational age of 25(1/7) weeks (IQR 1.66), a median birth weight of 750 g (IQR 327), and a median postnatal age of 14 days (IQR 12). Paracetamol was ineffective in 27/33 patients (82 %). Even more, after previous exposure to ibuprofen, this was even 100 %.

CONCLUSION:

In this study, paracetamol after ibuprofen treatment failure was not effective for PDA closure in VLBW infants. From the findings of this study, paracetamol treatment for PDA closure cannot be recommended for infants with a postnatal age >2 weeks. Earlier treatment with paracetamol for PDA might be more effective.

• Authors: Daniëlla W E Roofthooft, Ingrid M van Beynum, Johan C A de Klerk, Monique van Dijk, John N van den Anker, Irwin K M Reiss, Dick Tibboel, Sinno H P Simons
• Journal: European journal of pediatrics (Eur J Pediatr) Vol. 174 Issue 11 Pg. 1433-40 (Nov 2015) ISSN: 1432-1076 [Electronic] Germany
• PMID: 25922139 (Publication Type: Journal Article, Observational Study)

Chemical References

• Analgesics, Non-Narcotic
• Anti-Inflammatory Agents, Non-Steroidal
• Acetaminophen
• Ibuprofen

Topics

• Acetaminophen (administration & dosage, therapeutic use)
• Administration, Intravenous
• Analgesics, Non-Narcotic (administration & dosage, therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Cohort Studies
• Ductus Arteriosus, Patent (drug therapy)
• Female
• Gestational Age
• Humans
• Ibuprofen (therapeutic use)
• Infant, Newborn
• Infant, Premature
• Infant, Very Low Birth Weight
• Male
• Prospective Studies
• Treatment Failure
• Treatment Outcome