Towards rational management of patent ductus arteriosus: Ductal disease staging and first line paracetamol.

Aims: To study paracetamol (PCM) use as first line therapy for significant patent ductus arteriosus (sPDA) closure, stratified by echocardiography. Method(s): In this observational study, a pre-published score comprising PDA size & velocity, PDA: left pulmonary artery ratio, diastolic flow in main and LPA, LA: Ao ratio and left ventricular: aortic ratio were included for shunt severity. Successful closure was defined a priori as closure or >= 50% reduction in score. Comparisons were made between infants with sPDA who were treated and not treated. Result(s): During November 2017-18, 227 infants from 23-31+6 weeks' gestational age (GA) were admitted; 50 (22%) infants were diagnosed with PDA, 32 treated with PCM, overall treatment rate of 32/227 (14%). Successful therapy was noted in 23/32 (72%) and was higher when treated at <=7 days (80% vs 68%, P = 0.68), in infants >26 weeks GA (62.5 vs 100%, P = 0.07) and BW >1000 g (65.4 vs 100%, P = 0.14). Univariate analysis noted statistical significance only for GA. 18 infants were managed conservatively. Treated infants had a lower GA and BW, higher composite ECHO score (14.4 +/- 0.5 vs 19 +/- 0.4, P < 0.001). Conclusion(s): Composite scoring helped reduce exposure, and focus more on infants with lower GA and BWwith greater shunt severity.