Paracetamol on par with ibuprofen, indomethacin in neonatal patent ductus arteriosus

Paracetamol is as safe and effective as ibuprofen or indomethacin in the treatment of patent ductus arteriosus (PDA) in preterm neonates, suggests a recent study. In addition, use of paracetamol results in fewer adverse effects.

To define the comparative efficacy and safety of paracetamol compared to ibuprofen and indomethacin for PDA, a team of investigators conducted a systematic literature search in PubMed, Scopus, and Cochrane databases.

Randomized controlled trials that compared the efficacy and/or safety of paracetamol with ibuprofen and/or indomethacin were identified. Twenty studies, including a total of 1,718 neonates, met the eligibility criteria. All available data were then used in the meta-analysis.

Paracetamol showed no significant difference from ibuprofen or indomethacin on primary and overall PDA closure rates (primary: odds ratio [OR] vs ibuprofen, 0.93, 95 percent confidence interval [CI], 0.69‒1.26; p=0.650; OR vs indomethacin, 0.78, 95 percent CI, 0.20‒3.02; p=0.716; overall: OR vs ibuprofen, 1.17, 95 percent CI, 0.82‒1.66; p=0.394; OR vs indomethacin, 1.12, 95 percent CI, 0.58‒2.15; p=0.733).

Of note, paracetamol use led to a significant reduction in the risk of oliguria. It also resulted in less gastrointestinal bleeding.

“Ibuprofen and indomethacin are the preferred drug treatment for PDA in preterm neonates,” the investigators said. “The comparative safety and efficacy of paracetamol as an alternative has not yet been well established.”