Comparison of Gastrointestinal Complications of Paracetamol and Ibuprofen in the Management of Infants with Patent Ductus Arteriosus: A Randomized Clinical Trial Study

Gohar Shahmirzadi, Shamsollah Nooripour, Abbas Ziari, Navid Danaei


Background: Patent ductus arteriosus(PDA) is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with ibuprofen; however, this drug is associated
with many contraindications and potential side‑effects. In the past years, paracetamol has been proposed for the treatment of PDA. This study was designed to evaluate the efficacy and gastrointestinal complications of paracetamol and ibuprofen for the pharmacological closure of PDA in preterm infants.

Methods: In a clinical trial study, 40 preterm infants with echocardiographically confirmed PDA were randomly assigned to receive either paracetamol (n=23; 15mg/kg every 6 h for 2days) or ibuprofen(n=17; initial dose of 10mg/kg, followed by 5mg/kg every 12 h for 2days). The neonates matched for gestational age and weight. We used t‑test for parametric, Chi‑square for
categorial, and Wilcoxson for nonparametric variables. Significant level was considered less than 0.05.

Results: Platelet count, BUN and creatinine levels, and closure of PDA had not significant difference between two groups(P>0.05). Incidence and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen(P<0.05).

Conclusions: There were no differences in the rate of PDA closure between the two drugs, but with respect to complications, rate and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen. Therefore, paracetamol could not be used as a proper alternative agent for ibuprofen in the treatment of PDA in preterm infants


Acetaminophen; ductus arteriosus; ibuprofen; patent

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