Comparative Study of the Efficacy of Oral and Intravenous Acetaminophen in Closure of Patent Ductus Arteriosus of Preterm Neonates

Background and Aim: Patent ductus arteriosus (PDA) is a condition in premature infants that can cause dangerous complications such as renal dysfunction, intracerebral hemorrhage, necrotizing enterocolitis, and pulmonary dysplasia. This study was conducted to compare the efficacy of oral and intravenous acetaminophen in PDA improvement in preterm infants. Methods: This randomized clinical trial study was performed on 100 children. The patients were randomly divided into two groups. Group A received intravenous acetaminophen and group B was treated with oral acetaminophen for three consecutive days. Echocardiography was performed before and 3 and 6 days after the intervention. Results: Before the intervention, the prevalence of a small PDA was 72% and 76% and the prevalence of a large PDA was 28% and 24%, in group A and B, respectively. The second echocardiography showed a significant PDA improvement in both groups (p<0.001). The third echocardiography showed that all patients (100%) in the oral acetaminophen were treated while only three patients (6%) in the IV acetaminophen group had a large PDA. Intravenous injection of acetaminophen significantly decreased LA/AO (Left Atrial/Aortic root diameter) ratio from 1.46 to 1.27 (p=0.043). Similarly, oral acetaminophen declined LA/AO ratio from 2.0 to 1.30 (p=0.018). At the end of the second course of treatment, the prevalence of complete cure was 100% and 94% in groups A and B, respectively. Conclusion: Oral administration of acetaminophen improved PDA treatment without any adverse effects. Therefore, IV injection of acetaminophen can be replaced with oral acetaminophen for management of PDA in preterm infants.