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World J Clin Pediatr. Feb 8, 2016; 5(1): 75-81
Published online Feb 8, 2016. doi: 10.5409/wjcp.v5.i1.75
Oral medications regarding their safety and efficacy in the management of patent ductus arteriosus
Mehmet Yekta Oncel, Omer Erdeve
Mehmet Yekta Oncel, Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230 Ankara, Turkey
Omer Erdeve, Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine Children’s Hospital, 06100 Ankara, Turkey
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Omer Erdeve, MD, Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine Children’s Hospital, Dögol Caddesi, 06100 Ankara, Turkey. omererdeve@yahoo.com
Telephone: +90-505-4812151 Fax: +90-312-2362101
Received: September 28, 2015
Peer-review started: September 28, 2015
First decision: November 3, 2015
Revised: November 22, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 8, 2016
Abstract

Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants which is inversely related to birth weight and gestational age. Cyclooxygenase inhibitors such as indomethacin and ibuprofen which block the prostaglandin conversion from arachidonic acid are the most commonly used drugs for ductal closure. This review focuses on the safety and efficacy oral medications in the management of PDA in preterm infants. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects when compared to indomethacin. PDA closure rates are better with oral than with intravenous ibuprofen probably due to the pharmacokinetic of the drug. However, these medications were reported to be associated with several adverse including transient renal failure, gastrointestinal bleeding and perforation, hyperbilirubinemia and platelet dysfunction. Paracetamol seems be an alternative to PDA therapy with lower adverse events and side effects.

Keywords: Efficacy, Ibuprofen, Oral, Paracetamol, Patent ductus arteriosus, Preterm infant, Safety

Core tip: Regarding to the management of patent ductus arteriosus (PDA) in preterm infants, neonatologists and cardiologists have not reached a consensus on which PDAs to treat, when to treat, and how to treat. Currently, ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects when compared to indomethacin. PDA closure rates are better with oral than with intravenous ibuprofen. Recent studies suggest that paracetamol can be a medical alternative in the management of PDA with similar efficacy but lower side events than nonsteroidal anti-inflammatory drugs.