Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India Correspondence to: Prof. Ramesh Agarwal, Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Indian Pediatr. 2024 Jul 15;61(7):656-660. Epub 2024 May 25.
We evaluated ductal closure rates in preterm neonates with hemodynamically significant patent ductus arteriosus (hsPDA) who received paracetamol (PCM) as first-line therapy.
In this retrospective chart review, we included inborn preterm (< 37 weeks) neonates (January 2017-December 2021) with hsPDA (ductal diameter > 1.5 mm and left atrium-to-aortic root ratio (La/Ao > 1.4) who were treated with oral or intravenous PCM. Primary outcome was hsPDA closure (defined as small or no PDA) following 3-day treatment. Secondary outcomes were need for retreatment and surgical ligation, pulmonary hypertension (PH), and in-hospital morbidities.
Out of 2784 preterm birth, 117 neonates were diagnosed with hsPDA. Out of 96 neonates who received PCM in the first course, 20 died before the completing the first course. The median (IQR) gestation and birth weight of neonates who received PCM were 28 (26, 29) weeks and 841 (714, 1039) g, respectively. Out of 76 neonates who completed treatment with first course of PCM (57 intravenous, 19 oral), 43 (56.6%) achieved successful closure and five (6.6%) developed PH. Out of 14 neonates who received a second course of PCM, 10 achieved closure of hsPDA while one neonate expired.
Paracetamol is associated with successful closure of hsPDA in 56.6% of preterm neonates after one course and 70% of premies after two courses.
我们评估了接受对乙酰氨基酚（PCM）作为一线治疗的患有血液动力学显著动脉导管未闭（hsPDA）的早产儿的导管闭合率。
在这项回顾性图表审查中，我们纳入了患有 hsPDA（导管直径>1.5 毫米，左心房至主动脉根比值（La/Ao>1.4）的<37 周的内源性早产儿（2017 年 1 月至 2021 年 12 月），并接受口服或静脉注射 PCM 治疗。主要结局是 3 天治疗后 hsPDA 闭合（定义为小或无 PDA）。次要结局是需要再次治疗和手术结扎、肺动脉高压（PH）和住院并发症。
在 2784 例早产儿中，有 117 例被诊断为 hsPDA。在接受第一疗程 PCM 的 96 例新生儿中，有 20 例在完成第一疗程前死亡。接受 PCM 治疗的新生儿的中位（IQR）胎龄和出生体重分别为 28（26，29）周和 841（714，1039）克。在完成第一疗程 PCM 治疗的 76 例新生儿中（57 例静脉内，19 例口服），有 43 例（56.6%）成功闭合，有 5 例（6.6%）发生 PH。在接受第二疗程 PCM 的 14 例新生儿中，有 10 例 hsPDA 闭合，1 例新生儿死亡。
在第一疗程后，对乙酰氨基酚可使 56.6%的早产儿 hsPDA 成功闭合，在第二疗程后，70%的早产儿 hsPDA 成功闭合。
