Comparison of agents used in pda closure treatment in the newborn intensive care unit

Objective: Patent ductus arteriosus (PDA) is a common congenital heart disease, associated with significant morbidity and mortality in preterm infants. However, there is still no consensus on which approach is superior in the treatment of PDA. In our study, we aimed to compare the effectiveness of ibuprofen, paracetamol and combination (ibuprofen+ paracetamol) in the medical closure treatment of PDA in preterm infants diagnosed with hemodynamically significant PDA in the first 90 days of life, in terms of the number of cures, PDA closure status, morbidity and mortality. Materials and Methods: In this study, 60 preterm infants were retrospectively reviewed, who were born before 37 weeks of gestation and diagnosed with hemodynamically significant PDA, hospitalized at Afyonkarahisar Health Science University between 2018 and 2023. The cases were divided into two different groups according to their first cycle medical treatment preference, which is paracetamol or ibuprofen. The preterm infants included in the study were examined in terms of prenatal-natal characteristics, duct closure status, sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intra- ventricular hemorrhage and mortality. Data were analyzed with IBM SPSS Statistics 29. Results: As a first cure of closure treatment from 60 patients, 37 preterm infants had intravenous paracetamol treatment and 23 of them had perioral ibuprofen treatment. Prenatal- natal characteristics and first cycle closure rates were similar in both groups. BPD, ROP, and NEC rates were found to be higher in the paracetamol group than in the ibuprofen group (p=0,01, p=0,013, p=0,039, respectively).In the second course of closure treatment, combined treatment was applied to 5 babies, and PDA was closed in 3 of them without complications. It was observed that the PDA closed with the 3rd cure in two cases and the 4th cure in one case. Conclusion: The ductal closure success of paracetamol and ibuprofen in the treatment of PDA is compatible and similar to the literature. The higher rates of NEC, BPD, and ROP in the paracetamol group were associated with the preference for intravenous paracetamol in critical patient groups, such as those with feeding intolerance (abdominal bloating, NEC, etc.) and renal function test abnormalities. In preterm infants with appropriate clinical conditions, the duct can be closed with the third and fourth courses of mono or combined medical treatments before surgical intervention. Keywords: Combined Treatment, Ductus arteriosus, Ibuprofen, Paracetamol