Tekgündüz Kadir Şerafettin, Ceviz Naci, Caner İbrahim, Olgun Haşim, Demirelli Yaşar, Yolcu Canan, Şahin İrfan Oğuz, Kara Mustafa
1Division of Neonatology,Ataturk University Medical Faculty,Erzurum,Turkey.
2Department of Pediatric Cardiology,Ataturk University Medical Faculty,Erzurum,Turkey.
Cardiol Young. 2015 Aug;25(6):1060-4. doi: 10.1017/S1047951114001577. Epub 2014 Aug 27.
Haemodynamically significant patent ductus arteriosus is a significant cause of morbidity and mortality in pre-term infants. This retrospective study was conducted to investigate the usefulness of lower-dose paracetamol for the treatment of patent ductus arteriosus in pre-term infants.
A total of 13 pre-term infants who received intravenous paracetamol because of contrindications or side effects to oral ibuprofen were retrospectively enrolled. In the first patient, the dose regimen was 15 mg/kg/dose, every 6 hours. As the patient developed significant elevation in transaminase levels, the dose was decreased to 10 mg/kg/dose, every 8 hours in the following 12 patients. Echocardiographic examination was conducted daily. In case of closure, it was repeated after 2 days and when needed thereafter in terms of reopening.
A total of 13 patients received intravenous paracetamol. Median gestational age was 29 weeks ranging from 24 to 31 weeks and birth weight was 950 g ranging from 470 to 1390 g. The median postnatal age at the first intravenous paracetamol dose was 3 days ranging from 2 to 9 days. In 10 of the 13 patients (76.9%), patent ductus arteriosus was closed at the median 2nd day of intravenous paracetamol ranging from 1 to 4 days. When the patient who developed hepatotoxicity was eliminated, the closure rate was found to be 83.3% (10/12).
Intravenous paracetamol may be a useful treatment option for the treatment of patent ductus arteriosus in pre-term infants with contrindication to ibuprofen. In our experience, lower-dose paracetamol is effective in closing the patent ductus arteriosus in 83.3% of the cases.
血流动力学意义上的动脉导管未闭是早产儿发病和死亡的重要原因。本回顾性研究旨在探讨低剂量对乙酰氨基酚治疗早产儿动脉导管未闭的有效性。
回顾性纳入13例因口服布洛芬有禁忌证或副作用而接受静脉注射对乙酰氨基酚的早产儿。首例患者的给药方案为15mg/kg/剂量，每6小时一次。由于该患者转氨酶水平显著升高，随后12例患者的剂量减至10mg/kg/剂量，每8小时一次。每天进行超声心动图检查。若导管闭合，2天后复查，如有再通则按需复查。
13例患者接受了静脉注射对乙酰氨基酚。中位胎龄为29周（范围24至31周），出生体重为950g（范围470至1390g）。首次静脉注射对乙酰氨基酚时的中位出生后年龄为3天（范围2至9天）。13例患者中有10例（76.9%）在静脉注射对乙酰氨基酚的中位第2天（范围1至4天）动脉导管未闭闭合。排除发生肝毒性的患者后，闭合率为83.3%（10/12）。
静脉注射对乙酰氨基酚可能是对布洛芬有禁忌证的早产儿动脉导管未闭的有效治疗选择。根据我们的经验，低剂量对乙酰氨基酚在83.3% 的病例中可有效闭合动脉导管未闭。
