Acetaminophen to avoid surgical ligation in extremely low gestational age neonates with persistent hemodynamically significant patent ductus arteriosus

Objective:the objective of this study was to evaluate the effectiveness of rescue oral acetaminophen in improving echocardiography (echo) indices of patent ductus arteriosus (pda) shunt volume and avoiding surgical ligation in extremely low gestational age (ga) neonates (elgans, <28 weeks) with persistent pda.study design:retrospective cohort study of elgans with moderate or severe pda at risk for ligation after a practice change introducing oral acetaminophen (60 mg kg−1 day−1 for 3 to 7 days) to facilitate ductal constriction after indomethacin failure.results:twenty-six infants (median ga 24.4 weeks at birth) with persistent pda under consideration for surgical ligation were treated with oral acetaminophen at a mean of 27 days of life. echo indices of shunt volume improved in 12 (46%) infants (3 closed and 9 reduced to mild shunt), all of whom avoided ligation. there was no echo improvement in 14 (54%) infants, of which 8/14 underwent ligation, and ligation was deferred in 6/14 infants, mostly owing to improvement in respiratory stability. fewer responders than non-responders underwent ligation (0% vs 57%, p<0.01), though there were no differences in other neonatal outcomes.conclusions:in elgans with persistent significant pda, rescue therapy with oral acetaminophen was associated with improvement in echo indices of shunt volume and avoidance of ligation in nearly half of infants.