Luecke Caitlyn M, Liviskie Caren J, Zeller Brandy N, Vesoulis Zachary A, McPherson Christopher
Department of Pharmacy (CML, CJL, BNZ, CM), St. Louis Children's Hospital, St Louis, Missouri, Department of Pediatrics (ZAV, CM), Washington University School of Medicine, St Louis, Missouri.
J Pediatr Pharmacol Ther. 2017 Nov-Dec;22(6):461-466. doi: 10.5863/1551-6776-22.6.461.
Although non-steroidal anti-inflammatory drugs (NSAIDs) are the current standard therapy for the treatment of patent ductus arteriosus (PDA), many neonates have contraindications to receiving or may fail NSAID therapy. To avoid surgical ligation, these patients may benefit from an alternative therapy. The objective of this research is to report the efficacy and safety of acetaminophen for the treatment of PDA in a cohort of premature neonates.
Demographics and clinical course were retrospectively evaluated for all neonates admitted during the study period who received acetaminophen for the treatment of PDA. Initial acetaminophen dosing was 15 mg/kg every 6 hours (88% intravenous). Efficacy was analyzed from ductal constriction on echocardiogram as well as need for further PDA treatment. Markers of hepatic and renal function as well as respiratory support and neonatal morbidities were evaluated to describe the safety of acetaminophen.
Forty-one neonates were identified with a median birth weight of 760 g (IQR 614-948 g) and median gestational age of 25 weeks (IQR 24-27 weeks). Treatment was initiated at a median postnatal age of 15 days (IQR 8-19 days) for a median duration of 7 days (IQR 6-10 days). Twenty-seven neonates (66%) required no further PDA treatment, with echocardiographic PDA closure documented in 10 neonates (24%) and reduced ductal size in 15 neonates (37%). No clinically significant adverse effects attributable to acetaminophen therapy were detected.
Most patients in this study responded to acetaminophen treatment for PDA, indicating that this therapy may be an option for extremely low-birth-weight neonates in order to avoid surgical ligation.
尽管非甾体类抗炎药（NSAIDs）是目前治疗动脉导管未闭（PDA）的标准疗法，但许多新生儿存在接受该治疗的禁忌证或可能对NSAIDs治疗无反应。为避免手术结扎，这些患者可能受益于替代疗法。本研究的目的是报告对一组早产儿使用对乙酰氨基酚治疗PDA的疗效和安全性。
对研究期间因PDA接受对乙酰氨基酚治疗的所有新生儿的人口统计学和临床病程进行回顾性评估。初始对乙酰氨基酚剂量为每6小时15mg/kg（88%为静脉给药）。根据超声心动图上导管收缩情况以及进一步PDA治疗需求分析疗效。评估肝功能和肾功能指标以及呼吸支持和新生儿疾病情况以描述对乙酰氨基酚的安全性。
确定了41例新生儿，中位出生体重为760g（四分位间距614 - 948g），中位胎龄为25周（四分位间距24 - 27周）。治疗开始时的中位出生后年龄为15天（四分位间距8 - 19天），中位持续时间为7天（四分位间距6 - 10天）。27例新生儿（66%）无需进一步PDA治疗，10例新生儿（24%）超声心动图显示PDA闭合，15例新生儿（37%）导管尺寸减小。未检测到因对乙酰氨基酚治疗导致的具有临床意义的不良反应。
本研究中的大多数患者对用对乙酰氨基酚治疗PDA有反应，这表明该疗法可能是极低出生体重新生儿避免手术结扎的一种选择。
