Infant Journal
for neonatal and paediatric healthcare professionals

The PAIR trial: is paracetamol the way forward in management of hsPDA?

Currently, intravenous (IV) ibuprofen is the only licensed medication for the medical treatment of patent ductus arteriosus (PDA) in the UK; however, there is emerging evidence to suggest that paracetamol may be a promising alternative with fewer side effects. The PAIR pilot trial is the first study in the UK to investigate the efficacy and safety of IV paracetamol in comparison to IV ibuprofen for the management of haemodynamically significant PDA (hsPDA) in preterm infants. This article describes the rationale for the use of paracetamol and the design of the PAIR pilot trial, which will help to inform a much larger future study.

Arin Mukherjee
Consultant Neonatologist1 and Honorary Senior Lecturer2

Ruth Gottstein
Consultant Neonatologist1 and Honorary Lecturer3

Anupam Gupta
Consultant Neonatologist1 and Honorary Senior Lecturer2

1Department of Neonatology, St Mary’s Hospital, Manchester University NHS Foundation Trust
2University of Manchester
3School of Health and Society, Salford University

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patent ductus arteriosus; preterm infants; paracetamol; ibuprofen;
Key points
  1. Paracetamol appears to have similar efficacy to ibuprofen in treating hsPDA but with an improved safety profile.
  2. The PAIR pilot trial compares paracetamol to ibuprofen in managing hsPDA in infants born at <32 weeks’ gestation or birth weight <1,500g.

Also published in Infant:

Patent ductus arteriosus: are we treating the right ones?
Variability in the diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) can result in treating inconsequential PDAs and causes difficulty in interpreting clinical outcomes from the available literature. This study evaluates the echocardiogram parameters used to ascertain hsPDA in very low birth weight infants in a tertiary care centre in the UK. Extremely premature infants that received pharmacological or surgical treatment for a PDA were evaluated for basic characteristics, diagnostic echocardiograms, closure rates and eventual outcomes of persistent duct on follow-up.