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极低出生体重儿动脉导管对乙酰氨基酚或吲哚美辛的反应。

Response of the ductus arteriosus to acetaminophen or indomethacin in extremely low birth weight infants.

作者信息

Sutton Courtney C, Slaughter James C, Alrifai Mhd Wael, Hale Jennifer, Reese Jeff

机构信息

Department of Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, 37232, USA.

Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.

出版信息

J Perinatol. 2025 Mar;45(3):319-325. doi: 10.1038/s41372-024-02199-5. Epub 2024 Dec 18.

DOI:10.1038/s41372-024-02199-5
PMID:39695341
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11888984/
Abstract

OBJECTIVE

Acetaminophen and indomethacin are used for medical management of a patent ductus arteriosus. This study compared the efficacy of these agents in ELBW infants.

STUDY DESIGN

This was a retrospective study of all courses of indomethacin and acetaminophen. Baseline characteristics, details of pharmacologic therapy, toxicity, and acetaminophen serum concentrations were collected. The primary analysis compared rates of ductus closure with indomethacin versus acetaminophen using Pearson's Chi-squared test.

RESULTS

Ductus closure after a single course of therapy was similar between acetaminophen and indomethacin 16% vs. 18%, (p = 0.79). No differences were found in gestational age, birth weight, patient acuity, toxicity, or acetaminophen concentrations between those courses that resulted in closure compared to those that did not. When comparing single-agent exposure, indomethacin was initiated earlier (9.0 vs. 13.5 days, p = 0.022) but PDA closure rates were similar between groups.

CONCLUSION

Acetaminophen and indomethacin produced similar rates of ductus closure in this population.

摘要

目的

对乙酰氨基酚和吲哚美辛用于动脉导管未闭的药物治疗。本研究比较了这些药物在超低出生体重儿中的疗效。

研究设计

这是一项对所有吲哚美辛和对乙酰氨基酚治疗疗程的回顾性研究。收集了基线特征、药物治疗细节、毒性以及对乙酰氨基酚血清浓度。主要分析使用Pearson卡方检验比较了吲哚美辛与对乙酰氨基酚的动脉导管闭合率。

结果

对乙酰氨基酚和吲哚美辛单疗程治疗后的动脉导管闭合情况相似,分别为16%和18%,(p = 0.79)。在导致动脉导管闭合的疗程与未导致闭合的疗程之间,胎龄、出生体重、病情严重程度、毒性或对乙酰氨基酚浓度均未发现差异。比较单药治疗时,吲哚美辛开始用药时间更早(9.0天对13.5天,p = 0.022),但两组之间动脉导管未闭闭合率相似。

结论

在该人群中,对乙酰氨基酚和吲哚美辛的动脉导管闭合率相似。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979d/11888984/561deda366fd/41372_2024_2199_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979d/11888984/561deda366fd/41372_2024_2199_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979d/11888984/561deda366fd/41372_2024_2199_Fig1_HTML.jpg

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本文引用的文献

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J Pediatr Pharmacol Ther. 2023;28(7):618-627. doi: 10.5863/1551-6776-28.7.618. Epub 2023 Nov 23.
2
Acetaminophen versus indomethacin for patent ductus arteriosus management in premature infants: systematic review and meta-analysis of randomized controlled trials.对乙酰氨基酚与吲哚美辛用于早产儿动脉导管未闭治疗的比较:随机对照试验的系统评价和荟萃分析
Paediatr Child Health. 2023 Apr 4;28(5):291-298. doi: 10.1093/pch/pxac130. eCollection 2023 Aug.
3
Acetaminophen for the patent ductus arteriosus: has safety been adequately demonstrated?
对动脉导管未闭的乙酰氨基酚治疗:安全性是否得到充分证实?
J Perinatol. 2023 Oct;43(10):1230-1237. doi: 10.1038/s41372-023-01697-2. Epub 2023 May 11.
4
Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants.对早产儿或低出生体重儿的动脉导管未闭(patent ductus arteriosus),使用扑热息痛(acetaminophen,对乙酰氨基酚)。
Cochrane Database Syst Rev. 2022 Dec 15;12:CD010061. doi: 10.1002/14651858.CD010061.pub5.
5
Comparative safety and efficacy of paracetamol versus non-steroidal anti-inflammatory agents in neonates with patent ductus arteriosus: A systematic review and meta-analysis of randomized controlled trials.比较对患有动脉导管未闭的新生儿使用扑热息痛与非甾体抗炎药的安全性和疗效:一项随机对照试验的系统评价和荟萃分析。
Br J Clin Pharmacol. 2022 Jul;88(7):3078-3100. doi: 10.1111/bcp.15291. Epub 2022 Mar 15.
6
Paracetamol (acetaminophen) use in infants and children was never shown to be safe for neurodevelopment: a systematic review with citation tracking.对婴儿和儿童使用扑热息痛(对乙酰氨基酚)从未被证明对神经发育是安全的:一项有引文追踪的系统评价。
Eur J Pediatr. 2022 May;181(5):1835-1857. doi: 10.1007/s00431-022-04407-w. Epub 2022 Feb 17.
7
Pharmacokinetics of Intravenous Paracetamol (Acetaminophen) and Ductus Arteriosus Closure After Premature Birth.静脉注射扑热息痛(对乙酰氨基酚)的药代动力学与早产儿动脉导管闭合。
Clin Pharmacol Ther. 2021 Oct;110(4):1087-1095. doi: 10.1002/cpt.2380. Epub 2021 Aug 19.
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Acetaminophen Therapy for Persistent Patent Ductus Arteriosus.对持续性动脉导管未闭的乙酰氨基酚治疗。
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9
Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants.极度早产、极低出生体重儿的最大血管活性-正性肌力评分与死亡率。
J Perinatol. 2021 Sep;41(9):2337-2344. doi: 10.1038/s41372-021-01030-9. Epub 2021 Mar 12.
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Intravenous acetaminophen (at 15 mg/kg/dose every 6 hours) in critically ill preterm neonates with patent ductus arteriosus: A prospective study.静脉注射对乙酰氨基酚(每6小时15毫克/千克剂量)用于患有动脉导管未闭的危重新生儿:一项前瞻性研究。
J Clin Pharm Ther. 2021 Aug;46(4):1010-1019. doi: 10.1111/jcpt.13384. Epub 2021 Feb 27.