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Prophylactic intravenous paracetamol use in extremely premature infants for patent ductus arteriosus

Musa Silahli1, Zeynel Gokmen1, Mehmet Tekin2

  • 1Department of Pediatrics, Neonatal Intensive Care Unit, Baskent University Konya Practice and Research Center, Saray Street, 42080 Selcuklu, Konya, Turkey.

Journal of Basic and Clinical Physiology and Pharmacology
|September 30, 2021
PubMed

Insights

Prophylactic paracetamol in extremely low birth weight infants significantly reduced hemodynamically significant patent ductus arteriosus (hsPDA) and the need for repeat ibuprofen. However, it did not prevent retinopathy of prematurity and may worsen it.

Area of Science:

  • Neonatalogy
  • Pediatric Cardiology
  • Pharmacology

Background:

  • Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants.
  • Hemodynamic instability from PDA is linked to significant morbidities.
  • Evaluating interventions for hsPDA in ELBW infants is crucial.

Purpose of the Study:

  • To assess the efficacy of prophylactic intravenous paracetamol in preventing hemodynamically significant PDA (hsPDA) in ELBW infants.
  • To compare hsPDA rates and related morbidities between prophylactic paracetamol and no-prophylaxis groups.

Main Methods:

  • Retrospective study of 75 infants with gestational age <28 weeks.
  • Comparison between a prophylactic paracetamol group (n=35) and a control group (n=40).
  • Primary outcomes included ductal closure, ductal diameter, severe intraventricular hemorrhage (IVH), and need for repeat ibuprofen.

Main Results:

  • Significantly lower rates of hsPDA and smaller ductal diameters (>1 mm) in the prophylactic paracetamol group (p=0.004, p=0.013).
  • Reduced need for repeated ibuprofen courses for hsPDA treatment in the paracetamol group (p=0.025).
  • Male gender and paracetamol use were associated with increased likelihood of retinopathy of prematurity (ROP).

Conclusions:

  • Prophylactic paracetamol effectively decreases hsPDA likelihood in ELBW infants.
  • It reduces the need for repeated ibuprofen treatment for hsPDA.
  • Paracetamol prevents IVH but not ROP or bronchopulmonary dysplasia; it may worsen ROP. Further research is warranted.
Abstract

Keywords:
extremely low birth weight infantsparacetamolpatency of ductus arteriosus

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