(Screen 4 - 6:00 PM Friday) Efficacy and Safety of Intravenous Acetaminophen for the Treatment of the Persistent Patent Ductus Arteriosus in Neonates with Concomitant Critical Congenital Heart Disease

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Abstract: Introduction Persistent patent ductus arteriosus (PDA), in patients with concomitant critical congenital heart disease (CHD) such as defects with left to right shunt, is associated with worsening heart failure, and may accelerate the timing of surgery. Acetaminophen can be efficacious in closing PDA in very premature neonates. This case series assesses the efficacy and safety of acetaminophen treatment for PDA closure in patients with concomitant critical CHD.

Material and Methods This is a retrospective, single center study. Neonates with persistent PDA and concomitant critical CHD who underwent acetaminophen therapy for ductal closure were selected. Acetaminophen efficacy was assessed based on ductal constriction on echocardiogram. Markers of hepatic, renal, and respiratory function were evaluated pre- and post-therapy.

Results: 5 neonates met criteria for inclusion. 1 was term, 2 late preterm and 2 very preterm. Mean age at time of treatment was 8.4 days. The PDAs were moderate to large at the initiation of treatment. Acetaminophen was given intravenously at 15mg/kg every 6 hours. The mean duration of treatment was 4 days. At time of treatment completion, the PDA was closed in 2 patients, trivial in 1 and small in 2 patients. 4 out of 5 patients had complete PDA closure one week after treatment completion, with resultant decrease in diuretics and/or respiratory support. No adverse effects were identified.

Conclusions: Acetaminophen was efficacious and safe in closing persistent PDA in this small sample of patients with critical concomitant CHD. Further studies on the use of acetaminophen for PDA closure in this patient population is warranted.