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Enteral paracetamol or Intravenous Indomethacin for Closure of Patent Ductus Arteriosus in Preterm Neonates: A
Swarup Kumar Dash1, Nandkishor S Kabra, Bhupendra S Avasthi
1Department of Neonatology, Surya Childrens Hospital, Mangal Ashirwad, Santacruz West, Mumbai, India. Correspondence to: Dr Nandkishor S Kabra, Department of Neonatology, Surya Childrens Hospital, Mangal Ashirwad, Junction of S V Road and Dattatraya Road, Santacruz West, Mumbai 400 054, India. nskabra@gmail.com.
Objective:
To compare the efficacy of enteral paracetamol and intravenous indomethacin for closure of patent ductus arteriosus (PDA) in preterm neonates.
Design:
Randomized controlled trial.
Setting:
Level III neonatal intensive care unit.
Participants:
77 preterm neonates with birth weight ?1500 g and PDA size ?1.5 mm, with left to right ductal flow with left atrium to aortic root ratio >1.5:1; diagnosed by 2D-Echo within first 48 hours of life.
Intervention:
Paracetamol drops through the infant feeding tube (15 mg/kg/dose 6 hourly for 7 days) or intravenous indomethacin (0.2 mg/kg/dose once daily for 3 days).
Outcome Measures:
Primary: PDA closure rate assessed by echocardiography. Secondary: need for surgical closure of PDA, renal impairment, gastrointestinal bleed, necrotising enterocolitis, hepatotoxicity, pulmonary hemorrhage, sepsis, hypothermia, retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia and mortality.
Results:
PDA closure rate was 100% (36/36) in enteral paracetamol group as compared to 94.6% (35/37) in intravenous indomethacin group (P=0.13). The secondary outcomes were also similar between the two groups. There was no occurrence of hepatotoxicity.
Conclusions:
Enteral paracetamol is safe but not superior to intravenous indomethacin in the treatment of PDA in preterm neonates.
