1000
g birth weight [1]. This suggests the need to select candidates for
treatment of PDA judiciously. Treatment options for PDA include surgical
and pharmacological modalities. Conservative management includes fluid
restriction, and high positive end-expiratory pressure (PEEP) and low
inspiratory time (0.35s) during ventilation [2]. These approaches need
more scientific evidence, including randomized controlled studies. Also,
restricted fluid regimens and high PEEP are most difficult to follow in
extremely low gestational ages (<28 weeks). Pharmacological therapy is
thus the mainstay for treatment of PDA. Surgical therapy is often used
as a last resort for treatment of PDA.
Indomethacin and ibuprofen act by blocking the
conversion of arachidonic acid to prostaglandins, and have been
adequately studied for ductal closure [3]. However, due to their adverse
effects, paracetamol came up into clinical practice as a new treatment
option for PDA [1]. Paracetamol acts by directly inhibiting the activity
of prostaglandin synthase. Unlike ibuprofen, it is thought to act on
prostaglandin synthase at the peroxidase region of the enzyme. In 2011,
Hammerman, et al. [4] first published used paracetamol in preterm
infants with PDA. Thereafter, Oncel, et al. [5-7] published case
series about enteral and/or intravenous paracetamol treatment in preterm
infants with clinically significant PDA. These studies showed that
paracetamol is effective for treatment of PDA in preterm infants.
In this issue of Indian Pediatrics, Dash,
et al. [8] provide valuable new comparative data between enteral
paracetamol and intravenous indomethacin for closure of PDA in preterm
neonates. The investigators prospectively enrolled 171 preterm infants
with birthweight
1. Oncel MY, Yurttutan S, Erdeve O, Uras N, Altug N,
Oguz SS, et al. Oral paracetamol versus oral ibuprofen in the
management of patent ductus arteriosus in preterm infants: a randomized
controlled trial. J Pediatr. 2014;164:510-4.
2. Dani C, Bertini G, Corsini I, Elia S, Vangi V,
Pratesi S, et al. The fate of ductus arteriosus in infants at
23-27 weeks of gestation: from spontaneous closure to ibuprofen
resistance. Acta Paediatr. 2008;97:1176-80.
3. Demirel G, Erdeve O, Dilmen U. Pharmacological
management of PDA: oral vs intravenous medications. Curr Clin
Pharmacol. 2012;7:263-70.
4. Hammerman C, Bin-Nun A, Markovitch E, Schimmel MS,
Kaplan M, Fink D. Ductal closure with paracetamol: a surprising new
approach to patent ductus arteriosus treatment. Pediatrics.
2011;128:1618-21.
5. Oncel MY, Yurttutan S, Uras N, Altug N, Ozdemir R,
Ekmen S, et al. An alternative drug (paracetamol) in the
management of patent ductus arteriosus in ibuprofen-resistant or
contraindicated preterm infants. Arch Dis Child Fetal Neonatal Ed.
2013;98:F94.
6. Oncel MY, Yurttutan S, Degirmencioglu H, Uras N,
Altug N, Erdeve O, et al. Intravenous paracetamol treatment in
the management of patent ductus arteriosus in extremely low birthweight
infants. Neonatology. 2013;103:166-9.
7. Yurttutan S, Oncel MY, Arayici S, Uras N, Altug N,
Erdeve O, et al. A different first choice drug in the medical
management of patent ductus arteriosus: oral paracetamol. J Matern Fetal
Neonatal Med. 2013;26:825-7.
8. Dash SK, Kabra NS, Avasthi BK, Sharma SR, Padhi P,
Ahmed J. Enteral paracetamol or Intravenous indomethacin for closure of
patent ductus arteriosus in preterm neonates: a randomized controlled
trial. Indian Pediatr. 2015;52:573-78.
9. Dang D, Wang D, Zhang C, Zhou W, Zhou Q, Wu H.
Comparison of oral paracetamol versus ibuprofen in premature infants
with patent ductus arteriosus: a randomized controlled trial. PLoS
One. 2013;8:e77888.