title: Intravenous paracetamol for PDA closure in the preterm: a single-center experience.
abstract: Increasing recent evidence favors paracetamol use for patent ductus arteriosus (PDA) closure in preterms. Our study aims were (1) to assess efficacy and safety of intravenous (i.v.) paracetamol for PDA closure in a 23-32-week preterm population, as "first-line" (when traditional ibuprofen treatment was contraindicated) or "rescue" treatment (after ibuprofen failed), and (2) to identify predictors of PDA closure. The cumulative efficacy of consecutive cycles of i.v. paracetamol on PDA closure was confirmed after both "first-line" and "rescue" treatment, the overall PDA closure rates being, respectively, 56.7 and 61.1 % (p = 0.7624) after two cycles and 63.3 and 77.8 % (p = 0.2959) after three cycles. No toxicity was apparent after either "first-line" or "rescue" i.v. paracetamol treatment. On multivariate analysis, gestational age (GA) emerged as an independent predictor of PDA closure in the "first-line" i.v. paracetamol treatment group, while clinical risk index for babies (CRIB) score (a patient risk index based on birth weight, GA at birth, sex, patient's temperature on admission, and maximum base excess in first 12 h of life) was an independent predictor of PDA closure failure in the "rescue" group.
  
  
  CONCLUSIONS
  I.V. paracetamol proved effective in our study population. Randomized control trials (RCTs) are warranted to further investigate the efficacy and safety of i.v. paracetamol for PDA closure in preterms.
  
  
  BACKGROUND
  • Oral paracetamol has been judged as effective as oral ibuprofen for PDA closure in the preterm. • To date, only a handful of non-randomized studies exist to support the effectiveness of i.v. paracetamol in PDA closure. What is New: • Our observations confirm the clinical efficacy of i.v. paracetamol for PDA closure in a very low birth weight (VLBW)/extremely low birth weight (ELBW) preterm population. • Gestational age and CRIB score emerge as independent predictors of PDA closure.
authors.affiliation: Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padua, Medical School, Via Giustiniani, 3, 35128, Padova, Italy. enrico.valerio.md@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Valerio
authors.affiliation: Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padua, Medical School, Via Giustiniani, 3, 35128, Padova, Italy.
authors.forename: Marta Rossella
authors.initials: MR
authors.lastname: Valente
authors.affiliation: Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padua, Medical School, Via Giustiniani, 3, 35128, Padova, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Salvadori
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Medical School, Padova, Italy.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padua, Medical School, Via Giustiniani, 3, 35128, Padova, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
authors.affiliation: Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padua, Medical School, Via Giustiniani, 3, 35128, Padova, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Lago
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D061605:Administration, Intravenous; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies
chemical_list: D016861:Cyclooxygenase Inhibitors; D000082:Acetaminophen; D007052:Ibuprofen
keywords: Acetaminophen; Ibuprofen; Paracetamol; Patent ductus arteriosus; Preterm