Bardanzellu Flaminia, Neroni Paola, Dessì Angelica, Fanos Vassilios
Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, AOU and University of Cagliari, Cagliari, Italy.
Biomed Res Int. 2017;2017:1438038. doi: 10.1155/2017/1438038. Epub 2017 Jul 30.
In preterm infants, failure or delay in spontaneous closure of Ductus Arteriosus (DA), resulting in the condition of Patent Ductus Arteriosus (PDA), represents a significant issue. A prolonged situation of PDA can be associated with several short- and long-term complications. Despite years of researches and clinical experience on PDA management, unresolved questions about the treatment and heterogeneity of clinical practices in different centers still remain, in particular regarding timing and modality of intervention. Nowadays, the most reasonable strategy seems to be reserving the treatment only to hemodynamically significant PDA. The first-line therapy is medical, and ibuprofen, related to several side effects especially in terms of nephrotoxicity, is the drug of choice. Administration of oral or intravenous paracetamol (acetaminophen) recently gained attention, appearing effective as traditional nonsteroidal anti-inflammatory drugs (NSAIDs) in PDA closure, with lower toxicity. The results of the studies analyzed in this review mostly support paracetamol efficacy in ductal closure, with inconstant low and transient elevation of liver enzymes as reported side effect. However, more studies are needed to confirm if this therapy shows a real safety profile and to evaluate its long-term outcomes, before considering paracetamol as first-choice drug in PDA treatment.
在早产儿中，动脉导管（DA）自然闭合失败或延迟，导致动脉导管未闭（PDA），这是一个重大问题。PDA的长期存在可能与多种短期和长期并发症相关。尽管在PDA管理方面进行了多年的研究和积累了临床经验，但不同中心在治疗和临床实践异质性方面仍存在未解决的问题，特别是在干预时机和方式方面。如今，最合理的策略似乎是仅对血流动力学显著的PDA进行治疗。一线治疗是药物治疗，布洛芬是首选药物，但它有多种副作用，尤其是肾毒性方面。口服或静脉注射对乙酰氨基酚（扑热息痛）最近受到关注，在PDA闭合方面似乎与传统非甾体抗炎药（NSAIDs）一样有效，且毒性较低。本综述分析的研究结果大多支持对乙酰氨基酚在导管闭合方面的疗效，报告的副作用是肝酶偶尔出现低水平和短暂升高。然而，在将对乙酰氨基酚视为PDA治疗的首选药物之前，还需要更多研究来证实这种疗法是否具有真正的安全性，并评估其长期结果。
