{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:44:21Z","timestamp":1760150661637,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,17]],"date-time":"2023-12-17T00:00:00Z","timestamp":1702771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Introduction: Prophylactic paracetamol for extremely low gestation age neonates (ELGAN, &lt;27 weeks\u2019 gestation) with symptomatic patent ductus arteriosus (sPDA) in high-income countries (HIC) reduces medical and surgical interventions. Its effectiveness in low-to-middle-income countries (LMIC) remains uncertain. This study assesses prophylactic paracetamol\u2019s impact on sPDA interventions in ELGANs in an LMIC. Methods: This is a retrospective cohort study that compared a historical cohort of ELGANs that were treated with oral ibuprofen or intravenous paracetamol after diagnosis of sPDA (n = 104) with infants (n = 76) treated with prophylactic paracetamol (20 mg\/kg loading, 7.5 mg\/kg qid for 4 days), in a tertiary neonatal intensive care unit (NICU) in Vietnam. Oral ibuprofen or intravenous therapeutic paracetamol were administered if prophylactic paracetamol failed to close sPDA. Surgical ligation was conducted if targeted medical intervention failed, or the infant deteriorated from conditions attributable to sPDA. Results: In the historical cohort, 57 (55%) infants died within 7 days of life compared to 18 (24%) from the prophylactic cohort (p &lt; 0.01). Of the survivors, 21 (45%) of the historical and 23 (39.7%) of the prophylactic cohort required surgical ligation (p = 0.6). Duration of hospitalization for survivors was lower in the prophylactic cohort (mean 74 vs. 97 days, p = 0.01). In the prophylactic cohort, 24 (41%) infants did not need further treatment while 34 (59%) required further treatment including ibuprofen and\/or paracetamol 28 (48%) and surgical ligation 22 (38%). Conclusions: Prophylactic paracetamol for ELGAN in LMIC does not reduce the need for surgical ligation, sPDA rates, and other PDA-related morbidities in infants who survive beyond 7 days of age. It may reduce the risk of death and the duration of hospitalization but further study into the reasons behind this need to be determined with larger studies.<\/jats:p>","DOI":"10.3390\/children10121934","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T05:41:35Z","timestamp":1702878095000},"page":"1934","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prophylaxis of Patent Ductus Arteriosus with Paracetamol in Extremely Low Gestational Age Newborns (ELGANs): A Single-Institution Observational Study in Vietnam"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8198-3170","authenticated-orcid":false,"given":"Tinh Thu","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam"},{"name":"Neonatal Intensive Care Unit, Children\u2019s Hospital 2, Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dung Thi Ngoc","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Pediatric and Neonatology Department, Franco-Vietnamese Hospital, Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tam Thi Thanh","family":"Pham","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Children\u2019s Hospital 1, Ho Chi Minh City 700000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-3771","authenticated-orcid":false,"given":"Ju-Lee","family":"Oei","sequence":"additional","affiliation":[{"name":"School of Women\u2019s and Children\u2019s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia"},{"name":"Department of Newborn Care, The Royal Hospital for Women, Randwick, Sydney, NSW 2031, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sung, S.I., Chang, Y.S., Kim, J., Choi, J.H., Ahn, S.Y., and Park, W.S. (2019). Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23\u201328 weeks of gestation. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0212256"},{"key":"ref_2","first-page":"CD010061","article-title":"Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants","volume":"4","author":"Jasani","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_3","first-page":"CD013588","article-title":"Interventions for patent ductus arteriosus (PDA) in preterm infants: An overview of Cochrane Systematic Reviews","volume":"4","author":"Mitra","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1159\/000499361","article-title":"European Consensus Guidelines on the Management of Respiratory Distress Syndrome\u20132019 Update","volume":"115","author":"Sweet","year":"2019","journal-title":"Neonatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.pedneo.2019.10.002","article-title":"Therapeutic strategy of patent ductus arteriosus in extremely preterm infants","volume":"61","author":"Su","year":"2020","journal-title":"Pediatr. Neonatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1515\/jbcpp-2020-0006","article-title":"Prophylactic intravenous paracetamol use in extremely premature infants for patent ductus arteriosus","volume":"32","author":"Silahli","year":"2020","journal-title":"J. Basic. Clin. Physiol. Pharmacol."},{"key":"ref_7","first-page":"197","article-title":"Characteristics of patent ductus arteriosus in preterms with respiratory distress syndrome at Children\u2019s hospital 1","volume":"22","author":"Thu","year":"2018","journal-title":"Ho Chi Minh City J. Med."},{"key":"ref_8","first-page":"59","article-title":"Mortality and cost of treatment for extremely low gestational age neonates at NICU of Children\u2019s hospital 1 in Ho Chi Minh City\u2013Vietnam","volume":"23","author":"Tam","year":"2019","journal-title":"Ho Chi Minh City J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1542\/peds.2009-3506","article-title":"Patent ductus arteriosus of the preterm infant","volume":"125","author":"Hamrick","year":"2010","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1053\/siny.2000.0037","article-title":"Diagnosis of patent ductus arteriosus","volume":"6","author":"Skinner","year":"2001","journal-title":"Semin. Neonatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Atienza-Navarro, I., Alves-Martinez, P., Lubian-Lopez, S., and Garcia-Alloza, M. (2020). Germinal Matrix-Intraventricular Hemorrhage of the Preterm Newborn and Preclinical Models: Inflammatory Considerations. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21218343"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s40746-016-0048-6","article-title":"Therapeutic Options for Neonatal Acute Kidney Injury (AKI)","volume":"2","author":"Mian","year":"2016","journal-title":"Curr. Treat. Options Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000658-197801000-00001","article-title":"Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging","volume":"187","author":"Bell","year":"1978","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41390-019-0387-7","article-title":"Understanding the pathobiology in patent ductus arteriosus in prematurity\u2014Beyond prostaglandins and oxygen","volume":"86","author":"Hundscheid","year":"2019","journal-title":"Pediatr. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3389\/fped.2020.00130","article-title":"Late Administration of Surfactant May Increase the Risk of Patent Ductus Arteriosus","volume":"8","author":"Canpolat","year":"2020","journal-title":"Front. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s40748-021-00134-6","article-title":"Outcomes of neonatal hypothermia among very low birth weight infants: A Meta-analysis","volume":"7","author":"Mohamed","year":"2021","journal-title":"Matern. Health Neonatol. Perinatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1007\/s00431-015-2541-5","article-title":"Limited effects of intravenous paracetamol on patent ductus arteriosus in very low birth weight infants with contraindications for ibuprofen or after ibuprofen failure","volume":"174","author":"Roofthooft","year":"2015","journal-title":"Eur. J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1111\/apa.14137","article-title":"Intravenous paracetamol was associated with closure of the ductus arteriosus in extremely premature infants","volume":"107","author":"Saarela","year":"2018","journal-title":"Acta Paediatr."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/12\/1934\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:40:26Z","timestamp":1760132426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/12\/1934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,17]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["children10121934"],"URL":"https:\/\/doi.org\/10.3390\/children10121934","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2023,12,17]]}}}