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Here’s a summary of dosage, route, and duration of paracetamol for PDA closure in preterm neonates based on NHS survey data, published studies, and international reviews:
1. Typical UK/NHS Practice (survey data)
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Dose:
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Most units use 15 mg/kg per dose every 6 hours (enteral or IV).
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Route:
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Enteral (oral/NG) when tolerated.
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Intravenous (IV) if not tolerating feeds or if clinically unstable.
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Duration:
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Usually 3–5 days (median 3–4 days).
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Source: UK national survey of neonatal units (PubMed 32290734).
2. Research & Trial Protocols
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Oral regimen (early reports):
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15 mg/kg every 6–8 hours, 3–7 days.
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Successful closure reported in small cohorts (Hammerman et al., 2013; Oncel et al., 2013).
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IV regimen (when enteral not possible):
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15 mg/kg every 6 hours for 3–5 days.
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Sometimes extended up to 7 days if ductus remains open.
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Alternative lower-dose protocols:
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Some RCTs tested 7.5 mg/kg every 6 hours, but efficacy may be lower.
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3. Cochrane/Systematic Review Findings
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Most studies used 15 mg/kg q6h (IV or oral).
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Course length: usually 3–7 days, depending on closure.
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Evidence shows similar efficacy to ibuprofen/indomethacin with fewer GI/renal side effects, but long-term neurodevelopmental safety is uncertain.
Summary Table
| Parameter | Common Practice | Range in Literature |
|---|---|---|
| Dose | 15 mg/kg/dose | 7.5–15 mg/kg/dose |
| Frequency | Every 6 hours | Every 6–8 hours |
| Route | Oral/NG (preferred) or IV if needed | Oral, NG, IV |
| Duration | 3–5 days | 3–7 days |
📌 Monitoring:
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Some units check LFTs (liver function tests) and paracetamol serum levels during therapy, but this is not standardized across the NHS.
Would you like me to pull together a ready-to-use PDA treatment protocol (NHS-style guideline) with dosing, monitoring, and stepwise approach (NSAID first-line, paracetamol if contraindicated/failed)?
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