EC Paediatrics

Background: Ductus arteriosus is a vascular connection between the pulmonary artery and descending aorta. Which closes after birth, whereas if it remains patent it is called as patent ductus arteriosus (PDA). The incidence of PDA is inversely related to birth weight and gestational age (GA). In preterm infants it varies between 40% and 60% on the third day of life. This study shows paracetamol may be used as an alternative to other nonsteroidal anti-inflammatory drugs and is effective in ductal closure with minimal side effects.

Aim and Objective: Our study is aimed to determine the efficacy of oral paracetamol in closing hemodynamically significant patent ductus arteriosus in preterm infants.

Material and Methods: 25 preterm infants with hemodynamically significant PDA (hs-PDA) were treated with Paracetamol oral suspension, administered through an orogastric tube at 15 mg/kg per dose in 6 hourly intervals for 3 consecutive days. Transthoracic echocardiography will be done 24 hrs after the completion of course. PDA closure will be confirmed when there is no demonstrable open ductus or no flow on color Doppler. Those babies in whom hsPDA remained open or reopened, will receive a second course of the study drug. If the ductus remains open even after second course, is considered as failed.

Results: The effectiveness of the closure of the ductus arteriosus with paracetamol reported in our study was 88% (n = 22). Out of 22 cases of PDA closure, 14 cases (56%) had a positive response after one treatment course and 8 cases (32%) had a positive response after two treatment courses and 3 cases (12%) treatment failure.

Conclusion: Our results highlight that paracetamol could become not only an alternative treatment in closing PDA but also the treatment of choice in several scenarios. The use of oral paracetamol for ductus arteriosus closure could be effective and economical. Our data on the effectiveness of paracetamol in the treatment of PDA merits for conduction of further well designed and robust randomized control trials, to confirm the usefulness of paracetamol as first choice agent in management of PDA due to its lesser side effect profile.

 Keywords: Oral Paracetamol; Pre-term; Transthoracic Echocardiography; Colour Doppler; Hemodynamically Significant Patent Ductus Arteriosus

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