{"id":1740,"date":"2018-06-21T22:45:29","date_gmt":"2018-06-21T22:45:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1740"},"modified":"2018-06-21T22:48:26","modified_gmt":"2018-06-21T22:48:26","slug":"paracetamol-for-patent-ductus-arteriosus","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/06\/21\/paracetamol-for-patent-ductus-arteriosus\/","title":{"rendered":"Paracetamol for patent ductus arteriosus"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p><i><span style=\"font-weight: 400\">A recent review suggests paracetamol may be as effective as ibuprofen for the closure of patent ductus arteriosus. But there is much more to come with 19 more trials due to report.<\/span><\/i><\/p>\n<p style=\"text-align: right\">Carl Heneghan<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-thumbnail wp-image-1324 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2017\/06\/Carl-Heneghan-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/><\/p>\n<p><span style=\"font-weight: 400\">In preterm newborns, the mainstay of treatment for patent ductus arteriosus have been <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23633310\"><span style=\"font-weight: 400\">ibuprofen<\/span><\/a><span style=\"font-weight: 400\"> or surgery; however, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Hammerman+C%2C+Bin-Nun+A%2C+Markovitch+E%2C+Schimmel+MS%2C+Kaplan+M%2C+Fink+D.+Ductal+closure+with+paracetamol%3A+a+surprising+new+approach+to+patent+ductus+arteriosus+treatment.\"><span style=\"font-weight: 400\">case reports<\/span><\/a><span style=\"font-weight: 400\"> have suggested paracetamol might be a useful alternative, <\/span><\/p>\n<p><span style=\"font-weight: 400\">A recent <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29624206\"><span style=\"font-weight: 400\">Cochrane review <\/span><\/a><span style=\"font-weight: 400\">included eight RCTs (n=916 infants) of paracetamol for the closure of PDA. Five moderate quality trials (n=599) comparing paracetamol with ibuprofen found there was no overall difference in ductal closure rates. Four studies reported on gastrointestinal bleeding rates and found they were lower in the paracetamol group (NNT 17, 95% CI 11 to 50). Platelet counts and daily urine output were higher in the paracetamol group. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Paracetamol improved closure rates compared with placebo or no intervention in two low-quality trials of 80 infants (NNT 5, 95% CI 2 to 50). In the two low-quality studies comparing paracetamol with indomethacin (n=277),\u00a0there was no difference. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The authors concluded there is a need for longer-term studies given the concerns over neurodevelopmental problems following exposure to paracetamol, There are currently \u00a019 registered ongoing trials. This is, therefore, definitely one review update to watch out for. <\/span><\/p>\n<hr \/>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29624206\"><span style=\"font-weight: 400\">Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants<\/span><\/a><span style=\"font-weight: 400\">. Ohlsson A. &amp; Shah P.S. 2018. <\/span><i><span style=\"font-weight: 400\">Cochrane Database of Systematic Reviews<\/span><\/i><span style=\"font-weight: 400\">, <\/span><i><span style=\"font-weight: 400\">2018<\/span><\/i><span style=\"font-weight: 400\">(4), CD010061.<\/span><\/p>\n<p><strong>More from BMJ EBM<\/strong><\/p>\n<p><a class=\"highwire-cite-linked-title\" style=\"background-color: #ffffff;font-size: 1rem\" href=\"http:\/\/ebm.bmj.com\/content\/1\/6\/175\"><span class=\"highwire-cite-title\">Meta-analysis: Prophylactic indomethacin reduces patent ductus arteriosus and intraventricular haemorrhage in premature infants<\/span><\/a><span style=\"font-size: 1rem\">\u00a0\u00a0<\/span><span class=\"highwire-cite-metadata-journal highwire-cite-metadata\" style=\"font-size: 1rem\">Evidence-Based Medicine\u00a0<\/span><span class=\"highwire-cite-metadata-date highwire-cite-metadata\" style=\"font-size: 1rem\">Oct 1996,\u00a0<\/span><span class=\"highwire-cite-metadata-volume highwire-cite-metadata\" style=\"font-size: 1rem\">1\u00a0<\/span><span class=\"highwire-cite-metadata-issue highwire-cite-metadata\" style=\"font-size: 1rem\">(6)\u00a0<\/span><span class=\"highwire-cite-metadata-pages highwire-cite-metadata\" style=\"font-size: 1rem\">175;\u00a0<\/span><span class=\"highwire-cite-metadata-doi highwire-cite-metadata\" style=\"font-size: 1rem\"><span class=\"label\">DOI:<\/span>\u00a010.1136\/ebm.1996.1.175<\/span><\/p>\n<hr \/>\n<p>BMJ\u00a0<a href=\"http:\/\/ebm.bmj.com\/\">Evidence-Based Medicine<\/a>\u00a0\u2013\u00a0original evidence-based research, insights and opinion<\/p>\n<p>Read more in the <a href=\"http:\/\/ebm.bmj.com\/content\/early\/2018\/01\/24\/bmjebm-2018-110906\">Welcome to BMJ Evidence-Based Medicine Editorial<\/a>.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-1618 alignright\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1.png\" alt=\"\" width=\"280\" height=\"145\" \/><\/p>\n<hr \/>\n<p><b> Competing interests<\/b><\/p>\n<p>Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The NIHR Oxford BRC\u00a0 and the WHO. He has also received income from the publication of a series of toolkit books. CEBM jointly runs the\u00a0<a title=\"\" href=\"http:\/\/evidencelive.org\/\">EvidenceLive<\/a>\u00a0Conference with the BMJ and the\u00a0<a title=\"\" href=\"http:\/\/www.preventingoverdiagnosis.net\/\">Overdiagnosis Conference<\/a>\u00a0with some international partners which are based on a\u00a0 non-profit model.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; A recent review suggests paracetamol may be as effective as ibuprofen for the closure of patent ductus arteriosus. But there is much more to come with 19 more trials due to report. Carl Heneghan In preterm newborns, the mainstay of treatment for patent ductus arteriosus have been ibuprofen or surgery; however, case reports have [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/06\/21\/paracetamol-for-patent-ductus-arteriosus\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":1741,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14374,14388],"tags":[],"class_list":["post-1740","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-carl-heneghan","category-evidence-watch"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Paracetamol for patent ductus arteriosus - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/06\/21\/paracetamol-for-patent-ductus-arteriosus\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Paracetamol for patent ductus arteriosus - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"&nbsp; A recent review suggests paracetamol may be as effective as ibuprofen for the closure of patent ductus arteriosus. 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But there is much more to come with 19 more trials due to report. 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