Acetaminophen to avoid surgical ligation in extremely low gestational age neonates with persistent hemodynamically significant patent ductus arteriosus

D E Weisz; F F Martins; L E Nield; A El-Khuffash; A Jain; P J McNamara

doi:10.1038/jp.2016.60

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Acetaminophen to avoid surgical ligation in extremely low gestational age neonates with persistent hemodynamically significant patent ductus arteriosus

Journal article

Open access

Peer reviewed

Acetaminophen to avoid surgical ligation in extremely low gestational age neonates with persistent hemodynamically significant patent ductus arteriosus

D E Weisz, F F Martins, L E Nield, A El-Khuffash, A Jain and P J McNamara

Journal of perinatology, Vol.36(8), pp.649-653

08/2016

DOI: 10.1038/jp.2016.60

PMID: 27054842

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Abstract

The objective of this study was to evaluate the effectiveness of rescue oral acetaminophen in improving echocardiography (echo) indices of patent ductus arteriosus (PDA) shunt volume and avoiding surgical ligation in extremely low gestational age (GA) neonates (ELGANs, <28 weeks) with persistent PDA. Retrospective cohort study of ELGANs with moderate or severe PDA at risk for ligation after a practice change introducing oral acetaminophen (60 mg kg(-1) day(-1) for 3 to 7 days) to facilitate ductal constriction after indomethacin failure. Twenty-six infants (median GA 24.4 weeks at birth) with persistent PDA under consideration for surgical ligation were treated with oral acetaminophen at a mean of 27 days of life. Echo indices of shunt volume improved in 12 (46%) infants (3 closed and 9 reduced to mild shunt), all of whom avoided ligation. There was no echo improvement in 14 (54%) infants, of which 8/14 underwent ligation, and ligation was deferred in 6/14 infants, mostly owing to improvement in respiratory stability. Fewer responders than non-responders underwent ligation (0% vs 57%, P<0.01), though there were no differences in other neonatal outcomes. In ELGANs with persistent significant PDA, rescue therapy with oral acetaminophen was associated with improvement in echo indices of shunt volume and avoidance of ligation in nearly half of infants.

Canada

Hemodynamics

Echocardiography

Tertiary Care Centers

Ductus Arteriosus, Patent - drug therapy

Humans

Male

Treatment Outcome

Gestational Age

Ligation

Female

Infant, Extremely Premature

Retrospective Studies

Acetaminophen - therapeutic use

Ductus Arteriosus, Patent - diagnostic imaging

Cyclooxygenase Inhibitors - therapeutic use

Infant, Newborn

Details

Title: Subtitle: Acetaminophen to avoid surgical ligation in extremely low gestational age neonates with persistent hemodynamically significant patent ductus arteriosus
Creators: D E Weisz - Department of Paediatrics, University of Toronto, Toronto, ON, Canada
F F Martins - Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
L E Nield - Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
A El-Khuffash - School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland
A Jain - Department of Paediatrics, Mt Sinai Hospital, Toronto, ON, Canada
P J McNamara - Physiology and Experimental Medicine Program, SickKids Research Institute, Toronto, ON, Canada
Resource Type: Journal article
Publication Details: Journal of perinatology, Vol.36(8), pp.649-653
DOI: 10.1038/jp.2016.60
PMID: 27054842
ISSN: 0743-8346
eISSN: 1476-5543
Language: English
Date published: 08/2016
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093487202771

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