Paracetamol as an alternative method of treatment of hemodynamically significant PDA in preterm neonates - preliminary study

Introduction
Persistent ductus arteriosus (PDA) constitutes 5-10% of all inborn heart defects. In preterms born with body weight <1000 g is present eyen in 80%. Fast diagnosis and treatment of hemodynamically significant PDA (hsPDA) allows avoiding many complications. In pharmacological treatment of hsPDA conventionally inhibitors of cyclooxygenase (COX) are used but they may cause many side effects. That is why alternative methods are investigated. One of them is the use of paracetamol.

Aim of the study
The aim of our study was the assessment of effectiveness of paracetamol treatment of hsPDA in preterm neonates.

Material and methods
The study was performed in 10 preterm neonates, with hsPDA confirmed by echocardiography. 2 neonates were excluded from the study. In diagnosis we considered the width of arterial duct, presence of reverse flow in the descending aorta and clinical status of the patient. Paracetamol treatment was started after the cardiological confirmation of hsPDA, intravenously in dose of 15 mg/kg every 6 hours during 5 days +/- 2 days. In none of the patients included in our study side effects were observed.

Results
Effective treatment with paracetamol was observed in 62% studied neonates. In two of the remaining neonates treatment with ibuprofen was continued but the therapy also failed. In one contraindications of COX inhibitors treatment were present (thrombocytopenia). Eventually surgical ligation was performed in 3 of them.

Conclusions
Paracetamol can be used as an alternative method of treatment of hsPDA to ibuprofen.