Safety And Efficacy Of Paracetamol Vs Ibuprofen For Treatment Of Pda In Preterms:A Meta-analysis

Objective: To evaluate safety and efficacy of Paracetamol vs Ibuprofen in the treatment of PDA in preterms.Methods: A systematic literature search of Pub Med,Cochrane Library,Embase and Medline was conducted.Randomized Controlled trials of preterm PDA patients receiving Ibuprofen therapy vs Paracetamol therapy till january 2017 were searched.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data and evaluated the quality,and used Revman 5.3 software for statistical analysis.Results: Five studies with a total of 656 patients met the criteria.A total of 656 premature infants with patent ductus arteriosus were included in which 331 were in paracetamol group and 325 were in ibuprofen group.Meta-analysis results showed: There was no significant difference in total PDA closure rate between paracetamol and ibuprofen(OR: 1.27,95%CI: 0.82-1.97,P=0.28).There was no significant difference in the rate of PDA closure after the first course of treatment(OR:1.29,95%CI: 0.89-1.87,P=0.18).Paracetamol was associated with a statistically significant decrease in Gastrointestinal Bleeding(OR:0.25,95%CI: 0.10-0.65,P=0.005).All the other parameters such as Sepsis,Necrotising Enterocolitis(NEC),Intraventricular hemorrhage(IVH),Retinopathy of prematurity(ROP),Death,Pulmonary Hemorrahge,Oliguria,Bronchopulmonary Dysplasia(BPD)were found to be statistically similar.Conclusions: 1.The efficacy of paracetamol in the treatment of PDA is similar to that of ibuprofen.2.Paracetamol is less likely to cause gastrointestinal bleeding than ibuprofen.3.Although this study has evaluated the efficacy of paracetamol as an alternative treatment for PDA,further studies and more clinical trials are required to strengthen our conclusion.