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Oral Paracetamol for Patent Ductus Arteriosus Rescue Closure
Pramod Pharande1, Hadley Watson2, Kenneth Tan2,3
1Monash Newborn, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia. Pramod.Pharande@monashhelath.org.
Insights
Oral paracetamol effectively closed symptomatic patent ductus arteriosus (PDA) in 50% of infants when other treatments failed or were contraindicated. However, sepsis and furosemide use were linked to unsuccessful outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is a common condition in premature infants.
- First-line treatments for PDA, such as ibuprofen, may be ineffective or contraindicated.
- Alternative therapeutic options are needed for symptomatic PDA.
Purpose of the Study:
- To evaluate the efficacy of oral paracetamol as a 'rescue' therapy for symptomatic PDA.
- To identify factors associated with successful PDA closure using oral paracetamol.
Main Methods:
- Retrospective analysis of data from infants treated with oral paracetamol for PDA.
- Utilized a validated echocardiographic scoring system to assess ductal disease severity.
- Compared infants with successful closure versus partial or no closure using univariate analysis.
Main Results:
- Complete PDA closure was achieved in 50% of infants (10/20).
- An additional four infants showed significant reduction in haemodynamic shunting.
- Higher pre-therapy echocardiographic scores were associated with less successful closure.
- Concomitant furosemide therapy and late-onset sepsis were linked to unsuccessful closure.
Conclusions:
- Oral paracetamol may serve as a viable therapeutic option for PDA when first-line agents fail or are contraindicated.
- Sepsis and furosemide administration can negatively impact the success of oral paracetamol therapy for PDA.
- Further research is warranted to optimize paracetamol use in PDA management.
Abstract:
The objective of this study was to ascertain the efficacy of oral paracetamol in closing a symptomatic patent ductus arteriosus (PDA) when used as 'rescue' option. After obtaining ethics approval, a retrospective appraisal of the data from April 2014 to July 2015 was performed. Infants who were administered oral paracetamol either after unsuccessful therapy with ibuprofen or where it was considered contraindicated were included. A previously published echocardiographic scoring schema to stratify for ductal disease severity was used. Using univariate analysis, characteristics of infants with successful closure were compared with partial (a priori reduction in composite score by ≥ 50% of pretreatment) or no closure. Twenty infants with gestation age and birthweight of 25.7 ± 1.5 weeks and 724.1 ± 143 g, respectively, were studied. Complete closure was noted in 10 (50%) infants with additional four infants showing a significant reduction in haemodynamic shunting. Gestational age at birth and at therapy, chronological age at therapy, birthweight and total fluid intake were comparable between the two groups. The pre-therapy composite score had a significant association with successful closure (the higher the echocardiographic score, the lesser the closure). Concomitant furosemide therapy and late-onset sepsis had a high likelihood ratio of unsuccessful closure (11.01 [2-tailed, p = 0.005] and 5.3 [2-tailed, p = 0.07]), respectively. Oral paracetamol may be a possible therapeutic option in premature infants where therapy with first-line agents is unsuccessful or contraindicated. Concomitant sepsis and furosemide administration may affect successful therapy.
