Intravenous Paracetamol for Patent Ductus Arteriosus in Premature Infants - A Lower Dose Is Also Effective

babies with hsPDA. The first patient was a 29-week premature infant (birth weight 1,045 g, postnatal age 3 days). Oral ibupro-fen was contraindicated in this patient due to suspected necrotizing enterocolitis (NEC). We started IV paracetamol with the dose regimen suggested by Oncel et al. [1] . After the first 4 doses, transaminase levels were checked and a significant increase was detected compared to pretreatment levels (aspartate aminotransferase (AST) 43 vs. 260 U/l, alanine aminotransferase (ALT) 11 vs. 180 U/l). The drug was ceased and transaminase levels normalized over the following 4 days. After this experience, we decreased each dose to 10 mg/kg (3 doses/day). An echocardiographic study was per-formed after each of the 3 doses. If the duc-tal shunt had disappeared, treatment was stopped, but if it persisted, an additional 3 doses were given, for a maximum of 4 days. In 6 additional patients, IV paracetamol was used with this dosing regimen. All were very low birth weight infants. The gesta-tional ages were