Division of Neonatology, Careggi University Hospital of Florence, Viale Morgagni, 85, Florence, Firenze, Italy.
Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy.
Eur J Pediatr. 2018 Apr;177(4):533-539. doi: 10.1007/s00431-018-3086-1. Epub 2018 Jan 25.
Paracetamol seems to have similar success rates compared with indomethacin and ibuprofen in closing patent ductus arteriosus (PDA) in preterm infants, but with a better safety profile. The aim of our study was to evaluate the possible effects of paracetamol on cerebral oxygenation and cerebral blood flow velocity (CBFV). Infants with gestational age < 32 weeks with hemodynamically significant PDA (hsPDA) were prospectively studied by near infrared spectroscopy (NIRS) after the first dose of paracetamol (15 mg/kg) or ibuprofen (10 mg/kg). Cerebral regional oxygenation (rSOC) and fractional oxygen extraction ratio (FOEC) were recorded 30 min before (T) and 60 ± 20 min (T), 180 ± 30 min (T), and 360 ± 30 min (T) after the beginning of drug infusion. Moreover, mean flow velocity (Vmean) and resistance index (RI = PSV-DV/PSV) measured with Doppler ultrasound in pericallosal artery were recorded at the same times. Significant changes in rSOC and FOEC were not found during the study period within and between the groups. Similarly, Vmean did not vary in infants treated with paracetamol or ibuprofen, while RI decreased in the ibuprofen group.
The treatment of hsPDA with paracetamol does not affect cerebral oxygenation in very preterm infants; there were no differences in cerebral oxygenation in infants treated with paracetamol or ibuprofen, although in the ibuprofen group, the possible closure progression of PDA was associated to changes of RI. What is Known: • Paracetamol has similar success rates to indomethacin and ibuprofen in closing PDA with a better safety profile since previous studies did not report adverse effects. What is New: • Paracetamol does not affect cerebral oxygenation and perfusion in very preterm infants with PDA and this confirms its good safety profile.
与吲哚美辛和布洛芬相比，扑热息痛似乎在治疗早产儿动脉导管未闭（PDA）方面成功率相当，但安全性更好。我们的研究目的是评估扑热息痛对脑氧合和脑血流速度（CBFV）的可能影响。前瞻性研究了胎龄 < 32 周、存在血流动力学显著的 PDA（hsPDA）的婴儿，在首次给予扑热息痛（15mg/kg）或布洛芬（10mg/kg）后，通过近红外光谱（NIRS）进行评估。记录脑区域性氧合（rSOC）和氧摄取分数（FOEC），在药物输注开始前 30 分钟（T）和 60±20 分钟（T）、180±30 分钟（T）和 360±30 分钟（T）时。此外，在相同时间内，通过大脑正中动脉的多普勒超声测量平均流速（Vmean）和阻力指数（RI=PSV-DV/PSV）。在研究期间，各组内和组间 rSOC 和 FOEC 均无显著变化。同样，扑热息痛和布洛芬治疗的婴儿的 Vmean 没有变化，而布洛芬组的 RI 降低。
扑热息痛治疗 hsPDA 不会影响非常早产儿的脑氧合；扑热息痛和布洛芬治疗的婴儿脑氧合没有差异，尽管布洛芬组中，PDA 可能的关闭进展与 RI 的变化有关。已知：• 与吲哚美辛和布洛芬相比，扑热息痛在关闭 PDA 方面具有相似的成功率，且安全性更好，因为之前的研究未报告不良反应。新发现：• 扑热息痛不会影响存在 PDA 的非常早产儿的脑氧合和灌注，这证实了其良好的安全性。
