In the present trial, early, intravenous paracetamol is compared to placebo in extremely premature or low birth weight infants in order to evaluate the effect on ductal closure.
The purpose of this randomized, placebo-controlled, double-blind, phase 2, one center clinical trial is to study the efficacy and safety of early (\< 96 h) intravenous paracetamol in prophylactic closure of ductus arteriosus in extremely premature (gestational age \<28+0 wk, ELGA) or low birth weight (\<1000 g, ELBW) infants. The infants born extremely preterm or low birth weight are a focus of the study, since a small phase 2 study on paracetamol failed to demonstrate contraction of ductus arteriosus. In the investigator's previous cohort of ELGA/ELBW infants, the numbers of patients who needed any therapies for patent ductus arteriosus (PDA) were 29 (23%) in the paracetamol exposed group, and 90 (54%) in the control group. As demonstrated in a phase 2 study, the early paracetamol treatment induced the closure of ductus arteriosus: the mean (SD) ductal closure age was 177 (338) h in the whole paracetamol group. However, in the subgroup of ELGA infants born before 28 gestation weeks (n=14), the mean (SD) ductal closure ages in the paracetamol and placebo groups were 491 (504) h and 858 (719) h, respectively.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
40
Intravenous paracetamol solution for infusion
Half physiological saline solution as the non-active placebo solution
Department of Pediatrics, Oulu University Hospital
Oulu, Finland
Ductal closure
Postnatal age of the observed closure of ductus arteriosus
Time frame: Neonatal intensive care unit (NICU) treatment period up to 13 weeks
Near-infrared spectroscopy values
Near-infrared spectroscopy values
Time frame: Study drug period up to 10 days
Paracetamol serum levels
Paracetamol serum levels
Time frame: Study drug period up to 10 days
Paracetamol side effects
Any observed or detected paracetamol side effects
Time frame: Neonatal intensive care unit (NICU) treatment period up to 13 weeks
PDA
Open ductus arteriosus without any traditional PDA therapies
Time frame: Neonatal intensive care unit (NICU) treatment period up to 13 weeks
PDA, treated
The need for PDA therapies (ibuprofen, paracetamol, ligation)
Time frame: Neonatal intensive care unit (NICU) treatment period up to 13 weeks
Ventilatory assist
The duration of any ventilation assist, days
Time frame: Neonatal intensive care unit (NICU) treatment period up to 13 weeks
Complications of prematurity
The long term complications of prematurity (moderate-to-severe bronchopulmonary dysplasia (BPD), intraventricular hemorrhage gr 2-4, moderate to severe necrotizing enterocolitis, retinopathy of prematurity (ROP) needing therapy)
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Time frame: The first hospitalization period up to 19 weeks
Long term morbidity
Other long-term morbidity
Time frame: The first hospitalization period up to 19 weeks
Mortality
Mortality
Time frame: The first hospitalization period up to 19 weeks