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https://www.readbyqxmd.com/read/30323322/a-pilot-randomised-blinded-placebo-controlled-trial-of-paracetamol-for-later-treatment-of-a-patent-ductus-arteriosus
#1
Martin Kluckow, Hazel Carlisle, Margaret Broom, Patricia Woods, Michele Jeffery, Deepa Desai, Nick Evans
OBJECTIVE: To explore the efficacy and risks of oral paracetamol in later (>2 weeks old) treatment of patent ductus arteriosus (PDA). STUDY DESIGN: A multicentre double-blind placebo-controlled randomised pilot trial in three neonatal intensive care units in Australia. Infants born <33 weeks with haemodynamically significant PDA were treated with a 5-day course of oral paracetamol or placebo. Cardiac ultrasounds were used to document haemodynamic parameters...
October 15, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/30325529/follow-up-study-of-the-early-randomised-paracetamol-trial-to-preterm-infants-found-no-adverse-reactions-at-the-two-years-corrected-age
#2
S Juujärvi, H Kallankari, P Pätsi, M Leskinen, T Saarela, M Hallman, O Aikio
AIM: We examined the long-term outcomes and safety of early intravenous paracetamol for ductus arteriosus closure at a corrected age of two years. METHODS: This was a follow-up of the 2013-2014 randomised, double-blind Preterm Infant's Paracetamol Study at Oulu University Hospital, Finland, which recruited 48 very preterm infants within 24 hours of birth. They received intravenous paracetamol or a placebo for four days. In 2015-2017 we followed up 44 infants (92%) at two years of corrected age...
October 16, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/30264852/ibuprofen-for-the-treatment-of-patent-ductus-arteriosus-in-preterm-or-low-birth-weight-or-both-infants
#3
REVIEW
Arne Ohlsson, Rajneesh Walia, Sachin S Shah
BACKGROUND: Indomethacin is used as standard therapy to close a patent ductus arteriosus (PDA) but is associated with reduced blood flow to several organs. Ibuprofen, another cyclo-oxygenase inhibitor, may be as effective as indomethacin with fewer adverse effects. OBJECTIVES: To determine the effectiveness and safety of ibuprofen compared with indomethacin, other cyclo-oxygenase inhibitor(s), placebo, or no intervention for closing a patent ductus arteriosus in preterm, low-birth-weight, or preterm and low-birth-weight infants...
September 28, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/30120422/ductus-arteriosus-outcome-with-focus-on-the-initially-patent-but-hemodynamically-insignificant-ductus-in-preterm-neonates
#4
Daniel Fink, Itamar Nitzan, Alona Bin-Nun, Francis Mimouni, Cathy Hammerman
BACKGROUND/OBJECTIVES: The hemodynamically insignificant (hisPDA) ductus arteriosus often progresses to hemodynamic significance. In this review, we sought risk factors predictive of progression. METHODS: Early hisPDAs were subdivided into those that closed spontaneously vs. those that progressed to hsPDA. RESULTS: Sixty percent of early hisPDAs subsequently progressed to hsPDAs. In all but one, the ductus never closed, but rather became progressively more significant over time...
November 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/30040749/pre-symptomatic-targeted-treatment-of-patent-ductus-arteriosus-in-preterm-newborns-a-systematic-review-and-meta-analysis
#5
M A Farooqui, Y Elsayed, M M Jeyaraman, O Dingwall, M Tagin, R Zarychanski, R Rabbani, A M Abou-Setta
BACKGROUND: A clinically significant patent ductus arteriosus (PDA) is associated with significant morbidity and mortality in premature newborns. Symptomatic PDAs are often treated with prostaglandin synthesis inhibitors (PSI), but controversy remains if PSIs should also be used to manage early, asymptomatic PDAs. OBJECTIVE: To systematically identify, critically appraise, and evaluate the efficacy and safety of pharmacological management of pre-symptomatic PDA in preterm newborns after confirmed patency by echocardiography...
July 19, 2018: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/30007780/late-oral-acetaminophen-versus-immediate-surgical-ligation-in-preterm-infants-with-persistent-large-patent-ductus-arteriosus
#6
Sally Mashally, Lynne E Nield, Patrick J McNamara, Fernando F Martins, Afif El-Khuffash, Amish Jain, Dany E Weisz
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...
July 11, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29938546/the-dark-side-of-ibuprofen-in-the-treatment-of-patent-ductus-arteriosus-could-paracetamol-be-the-solution
#7
REVIEW
Laura Cuzzolin, Flamina Bardanzellu, Vassilios Fanos
Patent ductus arteriosus (PDA) persistence is associated, in prematures, to several complications. The optimal PDA management is still under debate, especially regarding the best therapeutic approach and the time to treat. The available drugs are not exempt from contraindications and side effects; ibuprofen itself, although representing the first-choice therapy, can show nephrotoxicity and other complications. Paracetamol seems a valid alternative to classic nonsteroidal anti-inflammatory Drugs, with a lower toxicity...
August 2018: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/29730050/hemodynamic-assessment-of-the-patent-ductus-arteriosus-beyond-ultrasound
#8
REVIEW
M Kluckow, P Lemmers
Assessment and management of a patent ductus arteriosus (PDA) in premature infants remains problematic. The more immature the infant, the more likely a PDA is to be present, due to lower spontaneous PDA closure rates. Clinicians now recognize that not all PDAs require treatment and that selection of the group of infants with a more hemodynamically relevant PDA, often manifesting as an increasing systemic-to-pulmonary shunt, is increasingly important. Ultrasound is the mainstay of diagnosis and physiological assessment of the PDA; however, there are other methodologies used to assess hemodynamic importance of the PDA...
August 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29663524/early-echocardiography-does-not-predict-subsequent-treatment-of-symptomatic-patent-ductus-arteriosus-in-extremely-preterm-infants
#9
Sujith S Pereira, Stephen T Kempley, Divyen K Shah, Joan K Morris, Ajay K Sinha
AIM: To determine whether early echocardiographic ductal parameters identified infants who subsequently received medical or surgical treatment of the patent ductus arteriosus (PDA). METHODS: Infants <29 weeks had PDA size in 2D and colour, flow velocity and patterns obtained on days 1 and 3. Infants were followed up to identify those subsequently receiving treatment for symptomatic PDA by clinicians who were unaware of scan results. Receiver operator characteristics curves and logistic regression were performed...
November 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29695206/efficacy-and-safety-of-oral-paracetamol-versus-oral-ibuprofen-for-closure-of-patent-ductus-arteriosus-in-preterm-infants-a-randomized-controlled-trial
#10
Rania A El-Farrash, Mohammed S El Shimy, Abeer S El-Sakka, Manal G Ahmed, Dina G Abdel-Moez
OBJECTIVE: The objective of this study is to evaluate the efficacy and safety of oral paracetamol versus oral ibuprofen in the treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. STUDY DESIGN: An interventional randomized case-control study, registered in ClinicalTrials.gov (NCT03265782), was conducted on 60 preterm infants with gestational age ≤34 weeks, postnatal age of 2-7 d and color Doppler echocardiographic evidence of hsPDA...
May 9, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29624206/paracetamol-acetaminophen-for-patent-ductus-arteriosus-in-preterm-or-low-birth-weight-infants
#11
REVIEW
Arne Ohlsson, Prakeshkumar S Shah
BACKGROUND: In preterm newborns, the ductus arteriosus frequently fails to close and the infants require medical or surgical closure of the patent ductus arteriosus (PDA). A PDA can be treated surgically; or medically with one of two prostaglandin inhibitors, indomethacin or ibuprofen. Case reports suggest that paracetamol may be an alternative for the closure of a PDA. An association between prenatal or postnatal exposure to paracetamol and later development of autism or autism spectrum disorder has been reported...
April 6, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29580939/non-pharmacological-management-of-a-hemodynamically-significant-patent-ductus-arteriosus
#12
A Smith, P J McNamara, A F El-Khuffash
The association between the patent ductus arteriosus (PDA) and neonatal morbidity, mortality and poor neurodevelopmental outcome in later childhood has been the focus of intense debate for decades. The lack of evidence supporting therapeutic strategies aimed at achieving PDA closure has led to the widespread adoption of conservative management aimed at mitigating the impact of shunt volume without achieving ductal closure. In this article, we review this management approach, describe the supportive evidence and potential complications associated with this strategy...
August 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29602579/continued-uncertainty-regarding-treatment-of-patent-ductus-arteriosus-in-premature-infants-and-the-role-of-clinical-trials
#13
REVIEW
Edmund Juszczak, Samir Gupta
Despite several decades of research into treatments for patent ductus arteriosus (PDA), there is continued uncertainty regarding whether, when, and how best to treat PDA and the long-term consequences. There are almost 5000 babies enrolled into clinical trials, but the questions remain largely unanswered. Many of the trials performed over the period were well designed and addressed important clinical questions, but the results are not necessarily directly applicable to the clinical management dilemmas of today since perinatal care has improved over time per se, the patient population is typically more premature, and there have been technological advances in diagnosis...
August 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29468349/prediction-of-therapeutic-response-to-cyclooxygenase-inhibitors-in-preterm-infants-with-patent-ductus-arteriosus
#14
REVIEW
Yang Hu, Hongfang Jin, Yi Jiang, Junbao Du
Patent ductus arteriosus (PDA) is a morbid condition commonly seen in premature infants. Cyclooxygenase (COX) inhibitors, such as indomethacin and ibuprofen, are often used for the treatment of PDA in preterm infants, and they work by reducing the production of prostaglandin. However, as observed in clinical practice, not all PDAs in preterm infants can be closed using COX inhibitors. Some studies have demonstrated that gestational age, birth weight, B-type natriuretic peptide (BNP), and ductal diameter can predict the therapeutic responsiveness to COX inhibitors...
April 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29343586/a-case-of-cardiomyopathy-due-to-premature-ductus-arteriosus-closure-the-flip-side-of-paracetamol
#15
Ingrid Anne Mandy Schierz, Mario Giuffrè, Ettore Piro, Simona La Placa, Giovanni Corsello
Paracetamol (acetaminophen or N-acetyl-p-aminophenol) is considered a safe analgesic and antipyretic nonsteroidal antiinflammatory drug commonly used during pediatric ages and during pregnancy. We report on a term neonate with closed ductus arteriosus, severe cardiomyopathy, right ventricular dysfunction, and functional stenosis of pulmonary arteries at birth after maternal self-medication with paracetamol and consumption of polyphenol-rich foods in late pregnancy. This drug, especially when associated with other vasoconstrictors (such as polyphenols), interferes with prostaglandin metabolism, which seriously accentuates the intrauterine ductus arteriosus constriction and leads to pharmacologic adverse events...
February 2018: Pediatrics
https://www.readbyqxmd.com/read/29306492/outcomes-of-surgical-ligation-after-unsuccessful-pharmacotherapy-for-patent-ductus-arteriosus-in-neonates-born-extremely-preterm
#16
Dany E Weisz, Lucia Mirea, Maura H F Resende, Linh Ly, Paige T Church, Edmond Kelly, S Joseph Kim, Amish Jain, Patrick J McNamara, Prakesh S Shah
A retrospective cohort study of neonates born extremely preterm with persistent patent ductus arteriosus after unsuccessful pharmacologic closure compared outcomes between 166 surgically ligated and 142 nonligated neonates. After adjustment for confounders, ligation was not associated with the composite outcome of death or neurodevelopmental impairment, neurodevelopmental impairment alone, chronic lung disease, or retinopathy of prematurity among survivors.
April 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29105147/intravenous-paracetamol-was-associated-with-closure-of-the-ductus-arteriosus-in-extremely-premature-infants
#17
S Juujärvi, T Saarela, M Hallman, O Aikio
AIM: Symptomatic patent ductus arteriosus may lead to serious complications in extremely preterm and extremely low birthweight infants and is often resistant to medication. We evaluated early intravenous paracetamol for pain prevention during respiratory therapy, in an attempt to understand the ductal treatment of such infants. METHODS: Our cohort were 295 extremely preterm or extremely low birthweight infants, born at less than 28 weeks or 1000 g, respectively, who were treated in the neonatal intensive care unit of Oulu University Hospital from 2002 to 2015, before and after intravenous paracetamol was introduced in June 2009...
April 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29119215/surgical-ligation-versus-percutaneous-closure-of-patent-ductus-arteriosus-in-very-low-weight-preterm-infants-which-are-the-real-benefits-of-the-percutaneous-approach
#18
COMPARATIVE STUDY
A Rodríguez Ogando, I Planelles Asensio, A Rodríguez Sánchez de la Blanca, F Ballesteros Tejerizo, M Sánchez Luna, J M Gil Jaurena, C Medrano López, J L Zunzunegui Martínez
Percutaneous treatment of patent ductus arteriosus (PDA) in extreme premature infants is technically difficult, and therefore, often not consider as an alternative to surgery. The main objective of our work was to compare respiratory status prior and post ductal closure and morbi-mortality, in our series of preterm infants with percutaneous PDA closure versus surgical ligation in the same time-period. Retrospective review of all premature infants submitted to percutaneous and surgical PDA closure from January 2011 to December 2016...
February 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29043398/oral-paracetamol-for-patent-ductus-arteriosus-rescue-closure
#19
Pramod Pharande, Hadley Watson, Kenneth Tan, Arvind Sehgal
The objective of this study was to ascertain the efficacy of oral paracetamol in closing a symptomatic patent ductus arteriosus (PDA) when used as 'rescue' option. After obtaining ethics approval, a retrospective appraisal of the data from April 2014 to July 2015 was performed. Infants who were administered oral paracetamol either after unsuccessful therapy with ibuprofen or where it was considered contraindicated were included. A previously published echocardiographic scoring schema to stratify for ductal disease severity was used...
January 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/28680875/echocardiographic-evaluation-of-patent-ductus-arteriosus-in-preterm-infants
#20
REVIEW
Romaine Arlettaz
Patent ductus arteriosus (PDA) is part of the typical morbidity profile of the preterm infant, with a high incidence of 80-90% in extremely low birth weight infants born before 26 weeks of gestation. Whereas spontaneous closure of the ductus arteriosus (DA) is likely in term infants, it is less so in preterm ones. PDA is associated with increased mortality and various comorbidities including cardiac failure, need for respiratory support, bronchopulmonary dysplasia, pulmonary or intracranial hemorrhage, and necrotizing enterocolitis; however, there is no proven causality between these morbidities and the presence of DA...
2017: Frontiers in Pediatrics
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