[Paracetamol could be useful in the treatment of patent ductus arteriosus in the very-low-birth-weight infant].

ଝ El paracetamol podría ser útil en el tratamiento del ductus arterioso persistente en el recién nacido de muy bajo peso Dear Editor, Patent ductus arteriosus (PDA) is frequently found in preterm newborns and its incidence increases with lower gestational age (GA), rising up to 60% in neonates of gestational ages 26 weeks and less. 1 Clinically, it is associated with an increase in morbidity and mortality, including pulmonary oedema and haemorrhage, intra-ventricular haemorrhage (IVH), necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity. The treatment of PDA includes fluid restriction, diuretics, nonselective cyclooxygenase (COX) inhibitors (indomethacin or ibuprofen) and, if all these fail, surgical closure. Recently, several authors have proposed the use of paracetamol for pharmacological closure of PDA if traditional medications fail or are contraindicated. As far as we know, there is no evidence on the use of paracetamol for this purpose in extremely preterm newborns in Spain. We present the cases of two patients with haemodynami-cally significant ductus (hsPDA) with contraindications for the administration of ibuprofen in which we tried alternative treatment with paracetamol before surgical closure. Cases (Table 1) 1. Twin, female, second-born at 26 +0/7 weeks of GA with a birth weight of 720 g. Prenatal corticosteroids administered. Delivery by urgent caesarean section due to placenta praevia. Apgar score: 6/8. Noninvasive ventilation until 14 h of life, when intubation and surfactant administration were required, with good response. Rein-tubation 12 h later due to clinical deterioration and NEC. Tw o days later a hsPDA, anaemia and thrombocytopaenia were detected. Consent was obtained from parents and treatment with intravenous (IV) paracetamol initiated. A control echocardiogram showed a closed ductus and normal haemodynamic parameters. Normal liver function. The patient evolved favourably and she was discharged at a postnatal age of 72 days. 2. Neonate, female, born at 23 +5/7 weeks of GA with a birth weight of 690 g. Chorioamnionitis. Prenatal corticosteroids (partial course). Vaginal delivery with cephalic presentation. Apgar score: 3/5. Intubated and given a dose of surfactant at birth. Mechanical ventilation and vasoactive medication since admission. On day 6, a hsPDA was diagnosed. Intravenous ibuprofen was initiated (one dose) and, with the verbal ଝ Please cite this article as: Pérez Domínguez ME, Rivero Rodríguez S, García-Muñoz Rodrigo F. El paracetamol podría ser útil en el tratamiento del ductus arterioso persistente en el recién nacido de muy bajo peso.