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Paracetamol-induced ductal closure in a 5-month-old infant

Published online by Cambridge University Press:  04 August 2014

Cynthia H. Ho ,
Gracie Galiza ,
Mahmood Ebrahimi  and
Merujan Y. Uzunyan
Cynthia H. Ho*
Affiliation:
Department of Pediatrics, Keck School of Medicine Los Angeles County + University of Southern California Medical Center, Los Angeles, California, United States of America Department of Internal Medicine, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, CaliforniaUnited States of America
Gracie Galiza
Affiliation:
Department of Pediatrics, Keck School of Medicine Los Angeles County + University of Southern California Medical Center, Los Angeles, California, United States of America
Mahmood Ebrahimi
Affiliation:
Department of Pediatrics, Keck School of Medicine Los Angeles County + University of Southern California Medical Center, Los Angeles, California, United States of America Division of Cardiology, Keck School of Medicine Los Angeles County + University of Southern California Medical Center, Los Angeles, California, United States of America
Merujan Y. Uzunyan
Affiliation:
Department of Pediatrics, Keck School of Medicine Los Angeles County + University of Southern California Medical Center, Los Angeles, California, United States of America Division of Cardiology, Keck School of Medicine Los Angeles County + University of Southern California Medical Center, Los Angeles, California, United States of America
*
Correspondence to: C. H. Ho, MD, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, 2020 Zonal Avenue, IRD Room 109 Los Angeles, CA 90033, United States of America. Tel: 323 226 3691; Fax: 323 226 5692; E-mail: cynho@usc.edu
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Abstract

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Type
Letter to the Editor
Information
Cardiology in the Young , Volume 25 , Issue 2 , February 2015 , pp. 400 - 401
Copyright
© Cambridge University Press 2014 

To the Editor,

Recently, we cared for a 5-month-old baby boy born at 28 weeks gestation with a 1.9-mm patent ductus arteriosus (Fig 1). The parents were counselled regarding the plan for percutaneous device closure and asked to return 2 weeks later. Surprisingly, on repeat echocardiogram, the ductus arteriosus had closed.

Figure 1 Transthoracic echocardiogram (parasternal short-axis view) at 51 weeks gestational age showing a patent ductus arteriosus and mildly dilated LA and left ventricle. AO=aorta; MPA=main pulmonary artery; LA=left atrium.

As spontaneous ductal closure is unusual past the newborn period, we questioned the parents about the events in the preceding 2 weeks. The parents reported administering paracetamol 12 mg/kg/dose twice daily for 4 days because of fussiness and nasal congestion. In premature infants during the newborn period, indomethacin or ibuprofen are first-line agents utilised for ductal closure. In patients with contraindications to non-steroidal anti-inflammatory drugs, paracetamol at 15 mg/kg/dose every 6 hours for 48 hours has been used effectively as a second-line agent.Reference Allegaert, Anderson, Simons and van Overmeire 1 , Reference Hammerman, Bin-Nun, Markovitch, Schimmel, Kaplan and Fink 2 Previous authors have suggested that paracetamol works by acting at the peroxidase segment of prostaglandin synthetase and inhibits activity.Reference Lucas, Warner, Vojnovic and Mitchell 3

To the best of our knowledge, our case is the first reported case of ductal closure associated with paracetamol outside of the newborn period. Further studies are needed to elucidate the role of paracetamol for ductal closure beyond the neonatal period.

Acknowledgements

C.H. drafted the initial manuscript, conducted the literature search, revised subsequent versions of the manuscript, and approved the final manuscript as submitted. G.G. performed the literature search, revised subsequent versions of the manuscript, and approved the final manuscript as submitted. M.E. revised subsequent versions of the manuscript and approved the final manuscript as submitted. M.U. revised subsequent versions of the manuscript and approved the final manuscript as submitted.

Financial Support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Conflicts of Interest

None.

Ethical Standards

The manuscript is original and has not been accepted or published elsewhere.

References

1. Allegaert, K, Anderson, B, Simons, S, van Overmeire, B. Paracetamol to induce ductus arteriosus closure: is it valid? Arch Dis Child 2013; 98: 462–466.Google Scholar
2. Hammerman, C, Bin-Nun, A, Markovitch, E, Schimmel, MS, Kaplan, M, Fink, D. Ductal closure with paracetamol: a surprising new approach to patent ductus arteriosus treatment. Pediatrics 2011; 128: e1618–e1621.CrossRefGoogle ScholarPubMed
3. Lucas, R, Warner, TD, Vojnovic, I, Mitchell, JA. Cellular mechanisms of acetaminophen: role of cyclo-oxygenase. FASEB J 2005; 19: 635–637.Google Scholar
Figure 0

Figure 1 Transthoracic echocardiogram (parasternal short-axis view) at 51 weeks gestational age showing a patent ductus arteriosus and mildly dilated LA and left ventricle. AO=aorta; MPA=main pulmonary artery; LA=left atrium.