To treat or not to treat? the efficacy of oral paracetamol for delayed closure of the ductus arteriosus; A case report

Published Date: 14th March 2017

Publication Authors: Brophy H, Bentur H, Abdelaziz M

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Background and aims 

Female infant was born at 29 weeks gestation. At one month of life this baby was self ventilating in air but having frequent profound desaturations requiring stimulation. These did not improve with blood transfusion nor anti reflux therapy. Weight gain was also suboptimal. Echocardiography demonstrated a large haemodynamically significant patent ductus arteriosus (PDA), with evidence of pulmonary hypertension and left -sided overload. 

Methods 

Following advice from the regional tertiary neonatal unit, three days of oral paracetamol at 15mg/kg four times daily were commenced with a view to closing the PDA. This was well tolerated. 

Results 

Post treatment echocardiography confirmed complete closure of the duct and the infant improved clinically. 

Conclusions 

This case report demonstrates successful late closure (beyond 10 days of life) of the PDA with oral paracetamol. El-Khuffash et al., 2015, also demonstrated successful late closure of the PDA in 9 of 36 infants treated with intravenous paracetamol. However, the quality of this evidence remains suboptimal as only a small number of neonates have so far received paracetamol treatment for late closure of the PDA. A trial of paracetamol, orally or intravenously, should therefore be considered for these babies.

Brophy, H; Bentur, H; Abdelaziz, M. (2016). To treat or not to treat? the efficacy of oral paracetamol for delayed closure of the ductus arteriosus; A case report . European Journal of Pediatrics. 175 (11), 1832

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