220 - Pharmacological Treatment of Patent Ductus Arteriosus: Comparison of a short versus prolonged strategy
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 220 Publication Number: 220.329
Sergio R. Vega, Universidad de Concepcion, Concepcion, Bio-Bio, Chile; Aldo Bancalari, Universidad de Concepcion, Concepcion, Bio-Bio, Chile; Scarlet A. Cotua, Hospital regional de Concepcion, Concepcion, Bio-Bio, Chile; Andres Marinovic, Guillermo Grant Benavente Hospital, Concepcion, Bio-Bio, Chile
felow Universidad de Concepcion Concepcion, Bio-Bio, Chile
Background: The use of intravenous (iv) acetaminophen has emerged as a good therapeutic option for hemodynamically significant patent ductus arteriosus (hsPDA). However, the duration of the treatment with this drug has not been well explored.
Objective: To compare the efficacy and safety of short versus prolonged treatment with acetaminophen of hsPDA in preterm infants.
Design/Methods: Study of 2 cohorts of very low birthweight newborns (≤ 32 weeks of gestational age (GA) and/or ≤ 1500 g) with an echocardiographic diagnosis of hsPDA. Group 1 is a prospective cohort that was treated with a short strategy (3 days) with iv acetaminophen (15 mg/kg/dose every 6 hours). Group 2 is a retrospective cohort that was treated with a prolonged strategy (6 days) with iv acetaminophen in the same doses. The evaluation of PDA closure was performed by echocardiography at the end of each treatment course. For the evaluation of side effects blood count, serum bilirubin, transaminases and prothrombin time before and after treatment were measured. For the statistical analysis, SPSS v.23 was used.
Results: 122 premature newborns were studied, 60 of them treated with the short strategy (Group 1), and 62 with the prolongedstrategy (Group 2). The mean birthweight and GA ± SD for Group 1 was 1145 ± 339 g and 28.3 ± 2.5 weeks and for Group 2, it was 1094 ± 257 g and 27.9 ± 2.1 weeks. The average pre-treatment ductal diameter was similar in both groups (Group 1: 2.35 ± 0.43 mm, Group 2: 2.20 ± 0.52 mm). The rate of ductal closure with the first treatment course in Group 1 was 66.7% (40/60), and 69.4% (43/62) in Group 2 (p = 0.75). This increased to 88.3% and 87.1% respectively after the second course of treatment (p = 0.84). In Group 1, 10% (6/60) of the premature infants required surgical closure, and in Group 2, 9.7% (6/62) (p = 0.95). In Group 1, no significant differences in laboratory tests were found between the pre and post-treatment values. However, in Group 2 there was a significant decrease in serum bilirubin and an increase in platelet count after treatment (p < 0.01). As to morbidities, there was a lower incidence of bronchopulmonary dysplasia (DBP) in Group 1 (43,3%) vs Group 2 (64,5%) (p=0,02).
Conclusion(s): Prolonged treatment of hsPDA with iv acetaminophen does not increase the rate of ductal closure compared to the short strategy. No increase in adverse effects was observed with the prolonged strategy. The prolonged strategy with acetaminophen does not seem to offer any advantages over the short strategy, and could be an association with higher incidence of DBP.
