Comparison of efficacy of paracetamol and ibuprofen used for closure of patent ductus arteriosus in premature infants

Introduction and Purpose: Congenital heart diseases are very common in premature babies. Patent Ductus Arteriosus (PDA) is the most common among congenital heart diseases. Patent ductus arteriosus can be treated primarily with medication as well as transcatheter and surgical treatment. In our study, we aimed to compare the efficacy of paracetamol and ibuprofen used for closure of PDA. Material and Method: Our study consisted of premature babies who received paracetamol or ibuprofen treatment for medical closure of PDA at Neonatology Service of Dicle University Medical Faculty between 1 January 2014 and 30 June 2017. Response to treatment of the premature infants, side effects of the treatment, the possible association of biochemistry and whole blood parameters with PDA closure was investigated. Complete ductus closure or the ductus diameters below 1.5 mm and the LA / Ao ratio below 1.5 were considered significant clinical responses. Results: A total of 63 infants were included in the study, 31 of them were female (49.2%) and 32 of them were male (50.8%). The mean birth week of the babies was 27.8 ± 3,1 weeks and the mean birth weight was 1178.4 ± 499.1 gram. 96.8% of the infants were diagnosed with respiratory distress syndrome (RDS) and 87.3% of them were given surfactant treatment. A large PDA was found on echocardiography (ECO) before all of the patients were treated. In addition to PDA, 12.6% of patients had additional cardiac pathologies such as atrial septal defect (ASD), ventricular septal defect (VSD). Medical closure applied with paracetamol in 32 patients (50.8%) which 8 of them received oral and the other 24 patients were given intravnouse treatment. On the other side, 31 patients received oral ibuprofen treatment (49.2%). Clinical response was obtained in all of the infants who received oral paracetamol and 75% of patients who received intravenous paracetamol treatment. When the babies who receiving intravenous and oral paracetamol were 7 evaluated together, clinical response was obtained in 81.2% of patients receiving paracetamol. It was observed that the patients who received ibuprofen clinical response in 77.4%. There was no significant difference between the patients who has non-cardiac pathologies such as retinopati of prematurite, bronkopulmoner displasia, necrotizing enterocolitis, intraventricular bleeding, sepsis, hyperbilirubinemia, renal pathology (P>0,05). There were no significant differences between the two treatment protocols in terms of side effects such as oliguria, elevation of blood urea nitrogen and creatinin levels, elevation of liver enzymes, thrombocytopenia. There was no significant relationship between pre-treatment and post-treatment platelet values and PDA diameters. Hemoglobin and hemotocrit values of the died were low, but blood urea nitrogen and creatinine values were higher. Seventeen patients in the study were died (12 patients recevied only 1 cure, and the other 5 patients was treated with 2 cures). In 11 of 17 patients, medical closure was achieved after 1 or 2 cures of treatment. The other 6 patients were died before the next medical PDA closure treatment or surgical ligation. It was observed that the PDA diameters of the patients who died were larger after treatment. Conclusion: In our study, we observed that paracetamol is as effective as ibuprofen in the medical treatment of PDA. Paracetamol and ibuprofen were compared ductal closure, reopening, surgical ligation rates were similar for both agents, and there was no difference in terms of complications and side effects. Keywords: PDA, Premature, Infant, Paracetamol, Ibuprofen.