Response of the ductus arteriosus to acetaminophen or indomethacin in extremely low birth weight infants

Abstract

Objective: Acetaminophen and indomethacin are used for medical management of a patent ductus arteriosus. This study compared the efficacy of these agents in ELBW infants. Study design: This was a retrospective study of all courses of indomethacin and acetaminophen. Baseline characteristics, details of pharmacologic therapy, toxicity, and acetaminophen serum concentrations were collected. The primary analysis compared rates of ductus closure with indomethacin versus acetaminophen using Pearson’s Chi-squared test. Results: Ductus closure after a single course of therapy was similar between acetaminophen and indomethacin 16% vs. 18%, (p = 0.79). No differences were found in gestational age, birth weight, patient acuity, toxicity, or acetaminophen concentrations between those courses that resulted in closure compared to those that did not. When comparing single-agent exposure, indomethacin was initiated earlier (9.0 vs. 13.5 days, p = 0.022) but PDA closure rates were similar between groups. Conclusion: Acetaminophen and indomethacin produced similar rates of ductus closure in this population.