Paracetamol Versus Ibuprofen in Closure of Patent Ductus Arteriosus in Premature Neonates,at Upper Egypt

The ductus arteriosus (DA) is an essential fetal blood vessel that connects the pulmonary artery to the aorta and serves to shunt blood away from the lungs into the umbilical placental circulation where gas exchange takes place.At birth, closure of the DA is a critical event in the transition to the postnatal circulatory pattern. However, there are situations in which DA closure does not occur or is delayed, resulting in the condition known as persistent patent DA (PDA) .

After birth, it usually closes within 48 h. A persistently PDA is diagnosed when the DA fails to close after 72 h.

PDA accounts for 5% to 10% of all congenital heart diseases. However, the incidence surges up to 60% in preterm infants and is inversely related to gestational age(GA) and birth weight.

The closure of the DA in full-term infants occurs in two steps. Initially, within the first few hours after birth,increased arterial PaO2 and decreased circulating prostaglandins allow the smooth muscle media of the ductus to constrict. As a result of the constriction, the inner muscle wall of the DA develops profound ischemic hypoxia which leads to the formation of vascular endothelial growth factor, transforming growth factor beta,and other inflammatory mediators and growth factors that transform the ductus into a non-contractile ligament.

The clinical consequences of PDA are related to the degree of left- to-right shunting through the PDA, with its associated change in blood flow to the lungs, kidneys, and intestine . This results in increased pulmonary blood flow and increased incidence of further comorbidities such as chronic lung disease, intraventricular hemorrhage(IVH), necrotizing enterocolitis (NEC), and retinopathy.Therefore, closure of the PDA is essential to prevent these complications and to improve both cardiorespiratory status and survival rate .