Patent Ductus Arteriosus Analysis

Patent Ductus Arteriosus (PDA) is a common finding in preterm infants, and can contribute to the development of other complications. The aim of this paper is to critique recent research and literature around the use of paracetamol in treating PDA.
Background
In the foetal circulation, the primary role of the DA is to divert the ventricular output away from the lungs towards the placenta in utero by its connection between the pulmonary artery and the descending aorta. Its patency is regulated by low oxygen tension present in the foetal lung and prostaglandin, which is known for its vasodilating effect in the placental circulation. Prostaglandin levels are usually high as a result of placental production and low clearance ability of the foetal
Some infants with PDA are asymptomatic with no intervention required, however, due to exposure to infection, they may need antibiotics to avoid the occurrence of bacterial endocarditis. Respiratory management is also essential because premature infants with symptomatic PDA may need prolonged respiratory support such as mechanical ventilation or continuous positive airway pressure (CPAP). Moreover, signs of congestive heart failure (CHF) must be closely monitored and reported, infants who developed CHF need diuretic and digoxin therapy, and regular blood testing to address electrolyte imbalances. Furthermore, fluid restriction can also have an impact on PDA closure, therefore, clinicians should have a good understanding of the cardiovascular and fluid changes that occurs after birth (Kim,
Several studies have shown that indomethacin and ibuprofen are highly effective in treating PDA, and has been identified as effective alternative to ibuprofen. This can be an option for infants at risk of the reported adverse effects of NSAIDs such as renal impairment, platelet aggregation, hyperbilirubinemia and decreased organ perfusion. If the duct was not successfully treated with these medications a surgical ligation is necessary to promote hemodynamic stability. The use of paracetamol has shown some therapeutic advantage. First, because of its vasoconstrictive effect, it promotes early closure of PDA. It can also be used for patients who have clinical contraindications for using NSAIDs, and it has the same effectiveness as ibuprofen. Therefore, the success of using paracetamol in very premature infants will depend on the dosing, duration of treatment, and mode of administration, and this needs to be further studied to develop a protocol for using this drug. However, there were only a few studies showing the safety of paracetamol to extremely premature infants which need to be explored more (Roofhooft, Beynum, & De Clerk,