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Infants with a gestational age < 37 weeks and who Had clinical signs of significant PDA within the first week of life, diagnosed by pediatric cardiologist were enrolled in the study after obtaining written consent from their parents.

Echocardiography for diagnosis of PDA was done by pediatric cardiologist. We considered PDA as a hemodynamically significant if the patients had at least one of these finding after 3 days or later: Respiratory or cardiovascular compromise (dependency to invasive ventilation or CPAP without RDS or extubation failure), large shunt (LA/AO ratio > 1.5 or sign of LA and LV dilation), PDA larger than 2.5 mm after 1 week, diastolic reversal flow in abdominal aorta after 3 days old (without aortic valve insufficiency), more than 40 mmHg difference between systole and diastole.

Treatment with high dose of intravenous route acetaminophen was started at a dose 20 mg/kg every 6 h for 4 d, with echocardiographic evaluation performed at the end of the treatment. The usual dose of acetaminophen in our center was 10 mg/kg per dose and most references indicates maximum 15 mg/kg/dose q6h for acetaminophen.

Treatment success was defined as complete ductal closure on echocardiography. Pre- and post-treatment levels of liver enzymes (alanine transaminase (ALT), aspartate aminotransferase (AST), albumin, total and direct bilirubin) were measured for evaluation liver toxicity.

Data analysis was done with SPSS version 19 and p value < 0.05 consider as significant.

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