The clinical utility of paracetamol serum concentration monitoring for patent ductus arteriosus treatment in preterm infants
Ali, Amira Koritena, Mahmoud Ahmed, Javeria Nazir, Mudasir Mcnulty, David Dabbour, Sherif Noureldein, Mona
Ali, Amira
Koritena, Mahmoud
Ahmed, Javeria
Nazir, Mudasir
Mcnulty, David
Dabbour, Sherif
Noureldein, Mona
Abstract
Objective: To evaluate whether paracetamol serum concentration monitoring is associated with ductal closure, hepatic or renal toxicity, and to assess the cost-effectiveness of routine serum monitoring in preterm infants treated for haemodynamically significant patent ductus arteriosus (hsPDA).
Study design: A multi-centre retrospective cohort study of 172 preterm infants treated with paracetamol for hsPDA (2018-2024). Associations between paracetamol serum concentrations, clinical outcomes, and monitoring costs were examined using multivariable mixed-effects modelling and micro-costing analysis.
Results: PDA closure after the first course occurred in 40.7%. On multivariate analysis, paracetamol concentration monitoring was not associated with PDA closure (OR 0.98, 95% CI:0.92-1.03, p = 0.68), ALT elevation (p = 0.443) or creatinine rise (p = 0.88). Across 222 assays, routine monitoring cost £6036 (£120.72 per actionable result) and remained non-cost effective across all sensitivity analyses.
Conclusion: Routine monitoring of paracetamol serum concentrations offers minimal clinical value and is not cost-effective. Selective, indication-based monitoring should replace universal testing.
MIDER Authors
Affiliations
Date
2026-06-22
Type
Article
Subject
Collections
Citation
Ali A, Koritena M, Ahmed J, Nazir M, Mcnulty D, Dabbour S, Noureldein M. The clinical utility of paracetamol serum concentration monitoring for patent ductus arteriosus treatment in preterm infants. J Perinatol. 2026 Jun 22. doi: 10.1038/s41372-026-02750-6. Epub ahead of print.