The effect of combined therapy for treatment of monotherapy-resistant PDA in preterm infants

Objective: Hemodynamically significant PDA (hsPDA) is one of the most common problems in preterm infants. This study was conducted to investigate the effect of combined pharmacological (paracetamol + ibuprofen) therapy on monotherapy-resistant hsPDA in infants.Subject and methods: The study included infants with persistent hsPDA, unresponsive to monotherapy. Combined treatment (paracetamol + ibuprofen) was started as paracetamol at a dose of 15 mg/kg every 6 hours for 5 days, and ibuprofen at an initial dose of 10 mg/kg followed by 5 mg/kg at 24 and 48 hours. Echocardiographic evaluation was performed at 2 days after the end of treatment. If hsPDA persisted after the combined treatment, a surgical PDA ligation was considered.Results: A total of 12 infants were enrolled and 9 infants (75%) with monotherapy-resistant PDA were successfully treated with combined therapy. In three patients, no response was obtained to the combined treatment so surgical ligation was applied.Conclusions: Combined therapy may be a useful treatment option for monotherapy-resistant hsPDA in preterm infants. Before surgical ligations, this combined therapy option should be considered.