Intravenous Paracetamol and Patent Ductus Arteriosus Closure

Standard medical treatments for patent ductus arteriosus (PDA) closure are, including indomethacin/ibuprofen and surgical ligation. Nowadays, a new strategy to close PDA is the use of paracetamol. The present study aimed to describe the use of intravenous (IV) paracetamol for PDA closure in neonates who present a contraindication to ibuprofen or ibuprofen failure with no possibility to perform surgical ligation due to major instability. The present study was conducted from January to December 2017 in the neonatal intensive care unit of Dr. Zainoel Abidin Hospital and Harapan Bunda Hospital, Banda Aceh, Indonesia, on neonates with hemodynamic significant PDA (hsPDA). All the subjects received IV paracetamol (15 mg/kg every 6 h) for 3 days. Thereafter, the ductus was evaluated by echocardiography on the 5th day after the regiment. A total of 72 neonates were diagnosed with hsPDA and their average of gestational age was 34.26 weeks and their average of birth weight was 1945.69 g for 39 (54.2%) female neonates, 33 (45.8%) male neonates, 45 (62.5%) premature infants, and 27 (37.5%) full-term infants. About 26 (36.1%) infants had a closed PDAs on the 5th days of evaluation, 11 (15.3%) infants had regiment twice for closed PDA at the 10th days of evaluation, and 35 (48.6%) neonates had more closed PDA after three or four regiments. Successful closure with paracetamol was achieved in 51(70.8%) neonates, while 21 (29.2%) neonates failed the PDA closure. Based on the findings of the present study, IV paracetamol appears to be reasonably effective for PDA closure in both preterm and term infants. This should be the first-line of therapy choice when there are contraindications for the treatment with ibuprofen.