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J Thorac Cardiovasc Surg. 2018 Nov;156(5):1937-1944. doi: 10.1016/j.jtcvs.2018.05.098. Epub 2018 Jul 11.

Late oral acetaminophen versus immediate surgical ligation in preterm infants with persistent large patent ductus arteriosus.

Author information

1
Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
2
Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
3
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Physiology and Experimental Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada.
4
Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
5
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
6
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada.
7
Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: dany.weisz@sunnybrook.ca.

Abstract

OBJECTIVE:

The study objective was to evaluate the association of oral acetaminophen therapy versus immediate surgical ligation with neonatal outcomes in infants with persistent patent ductus arteriosus.

METHODS:

We performed a retrospective cohort study of preterm infants born 28+6 weeks or less gestational age with persistent large patent ductus arteriosus being considered for surgical ligation after unsuccessful medical therapy. Infants in epoch 1 (July 2009 to June 2012) were immediately referred for ligation, and infants in epoch 2 (July 2012 to June 2015) were treated with oral acetaminophen and referred for ligation in the absence of improvement. The primary outcome was a composite of death or chronic lung disease.

RESULTS:

A total of 92 infants with median (interquartile range) gestational age 25.2 weeks (24.4-26.3) had persistent large patent ductus arteriosus (43 in epoch 1, 49 in epoch 2). Infants in epoch 2 had decreased surgical ligation (26 [53%] vs 31 [72%]; adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.12-0.89) but increased chronic lung disease (36 [73%] vs 25 [58%]; aOR, 3.34; 95% CI, 1.05-10.58) and increased death/chronic lung disease of borderline significance (39 [80%] vs 29 [67%]; aOR, 3.09; 95% CI, 0.99-9.63). Infants in epoch 2 took longer to wean off of positive pressure ventilation (28.5 vs 24 days after enrollment; aOR, 0.52; 95% CI, 0.31-0.85).

CONCLUSIONS:

Late oral acetaminophen therapy for infants with persistent patent ductus arteriosus is associated with reduced surgical ligation but increased chronic lung disease. In light of a lack of improvement in clinical outcomes, the individual contributory effects of acetaminophen, surgical ligation, and prolonged exposure to patent ductus arteriosus require further study to define the optimal approach.

KEYWORDS:

ELGAN; PDA; acetaminophen; bronchopulmonary dysplasia; mortality

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