Patent Ductus Arteriosus Closure by Paracetamol in a Critical Preterm Infant after Late Recanalization

Cyclooxygenase (COX) inhibitors form the first line of treatment for patent ductus arteriosus (PDA) in preterm neonates. However, their efficacy decreases with increasing postnatal age. Paracetamol can be used when COX inhibitors are contraindicated and in advanced postnatal age. We describe a late preterm neonate (five weeks postnatal age, 1550 g birth weight) with a hemodynamically significant PDA, where COX inhibitor therapy could not be initiated due to spontaneously perforated necrotizing enterocolitis that was treated surgically. At five weeks postnatal age and body weight of 1800 g intravenous paracetamol was started. Over a 3-day course, it led to complete closure of the PDA. With follow up three months after treatment, recanalization occurred but did not need further attention.