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Effect on cerebral oxygenation of paracetamol for patent ductus arteriosus in preterm infants

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Abstract

Paracetamol seems to have similar success rates compared with indomethacin and ibuprofen in closing patent ductus arteriosus (PDA) in preterm infants, but with a better safety profile. The aim of our study was to evaluate the possible effects of paracetamol on cerebral oxygenation and cerebral blood flow velocity (CBFV). Infants with gestational age < 32 weeks with hemodynamically significant PDA (hsPDA) were prospectively studied by near infrared spectroscopy (NIRS) after the first dose of paracetamol (15 mg/kg) or ibuprofen (10 mg/kg). Cerebral regional oxygenation (rSO2C) and fractional oxygen extraction ratio (FOEC) were recorded 30 min before (T0) and 60 ± 20 min (T1), 180 ± 30 min (T2), and 360 ± 30 min (T3) after the beginning of drug infusion. Moreover, mean flow velocity (Vmean) and resistance index (RI = PSV-DV/PSV) measured with Doppler ultrasound in pericallosal artery were recorded at the same times. Significant changes in rSO2C and FOEC were not found during the study period within and between the groups. Similarly, Vmean did not vary in infants treated with paracetamol or ibuprofen, while RI decreased in the ibuprofen group.

Conclusion: The treatment of hsPDA with paracetamol does not affect cerebral oxygenation in very preterm infants; there were no differences in cerebral oxygenation in infants treated with paracetamol or ibuprofen, although in the ibuprofen group, the possible closure progression of PDA was associated to changes of RI.

What is Known:

• Paracetamol has similar success rates to indomethacin and ibuprofen in closing PDA with a better safety profile since previous studies did not report adverse effects.

What is New:

• Paracetamol does not affect cerebral oxygenation and perfusion in very preterm infants with PDA and this confirms its good safety profile.

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Abbreviations

CHD:

congenital heart disease

LVO:

left ventricular output

NIRS:

near infrared spectroscopy

PI:

perfusion index

RVO:

right ventricular output

SpO2 :

pulse-oximetry

SVCf:

superior vena cava flow

VTI:

velocity time integral

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Funding

This study was carried out without specific funding.

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Authors and Affiliations

  1. Division of Neonatology, Careggi University Hospital of Florence, Viale Morgagni, 85, Florence, Firenze, Italy

    Carlo Dani, Chiara Poggi, Ilaria Cianchi, Iuri Corsini, Venturella Vangi & Simone Pratesi

  2. Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy

    Carlo Dani

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  1. Carlo Dani
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Contributions

CD designed the study, supervised data collection, carried out the analyses, drafted the manuscript, and approved the final manuscript as submitted. CP, IC, IC, VV, and SP performed the data collection, participated in data analysis, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Carlo Dani.

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Conflict of interest

Carlo Dani has served as consultants to Angelini ACRAF Spa on paracetamol PDA closure in preterm infants. The other authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Communicated by: Patrick Van Reempts

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Dani, C., Poggi, C., Cianchi, I. et al. Effect on cerebral oxygenation of paracetamol for patent ductus arteriosus in preterm infants. Eur J Pediatr 177, 533–539 (2018). https://doi.org/10.1007/s00431-018-3086-1

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  • DOI: https://doi.org/10.1007/s00431-018-3086-1

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