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Oral versus intravenous paracetamol for patent ductus arteriosus closure in preterm infants

Pediatric Research volume 92, pages 1146–1152 (2022)Cite this article

Abstract

Background

To examine whether oral administration of paracetamol as a first-line agent had a greater effect on the closure of a patent ductus arteriosus than the intravenous route.

Methods

We performed a retrospective study of preterm infants (<37 weeks of gestation) between 2012 and 2020 treated with oral or intravenous paracetamol as the first line for patent ductus arteriosus (PDA) constriction and compared rates of ductal closure, course duration, cumulative dose, PDA characteristics, and serum levels.

Results

Over the study period, 80 preterm infants received paracetamol, of which 50 received paracetamol as first-line treatment to augment constriction of the PDA. Closure rate was higher in the oral group (n = 15/19, 79%) compared to the intravenous group (n = 8/20, 40%, p < 0.01), and remained significant after adjusting for gestational age, length of treatment, and postnatal age (OR 0.14, 95% CI 0.03–0.67, p = 0.014, RR 0.51, 95% CI 0.28–0.91). Eleven preterm infants received a combination of both oral and intravenous paracetamol with a closure rate of 45% (n = 5).

Conclusions

Oral administration of paracetamol as a first-line agent is more efficacious to constrict the PDA than the intravenous route, irrespective of gestational age or course duration.

Impact

  • Our retrospective study comparing the use of oral versus intravenous paracetamol as the first line for patent ductus arteriosus (PDA) constriction in preterm infants demonstrates that oral administration of paracetamol is more efficacious to constrict the PDA than the intravenous route, irrespective of gestational age or course duration.

  • To our knowledge, this is the first published study (prospective or retrospective) to compare the efficacy of oral versus intravenous paracetamol as a first-line treatment for PDA closure in preterm infants.

  • Our finding may improve the rate of PDA closure when paracetamol is used as a first-line agent.

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Fig. 1

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Authors and Affiliations

  1. Carmel Medical Center, 7th Michal St., Haifa, Israel

    Ayala Gover, Avi Rotschild, Marcelo Golzman, Michal Molad, Karen Lavie-Nevo & Irena Kessel

  2. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Ayala Gover, Avi Rotschild, Michal Molad, Karen Lavie-Nevo & Irena Kessel

  3. Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, USA

    Philip T. Levy

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Contributions

G.A.: study conception and design, acquisition of data, analysis and interpretation of data, and the first draft of the manuscript. P.T.L./R.A./G.M./M.M./L.-N.K.: substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, revising the article critically for important intellectual content, and final approval of the version to be published. K.I.: study design, acquisition of data, revising the article critically for important intellectual content, and final approval of the version to be published.

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Correspondence to Ayala Gover.

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Gover, A., Levy, P.T., Rotschild, A. et al. Oral versus intravenous paracetamol for patent ductus arteriosus closure in preterm infants. Pediatr Res 92, 1146–1152 (2022). https://doi.org/10.1038/s41390-022-01944-w

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