771 - "To Treat Or Not To Treat Beyond Three Days". Acetaminophen for treatment of the patent ductus arteriosus

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 771
Publication Number: 771.148

Nisha A. Qazi, St. Joseph's Children's Hospital, Hackensack, NJ, United States; somia shaheen, St. Joseph's Children's Hospital, Paterson, NJ, United States; kiran bhat, St Josephs Medical Center, Cresskill, NJ, United States; Kiblawi Fuad, St. Joseph's Children's Hospital, Wayne, NJ, United States

Presenting Author(s)

Nisha Altaf Qazi (she/her/hers)

Resident Physician
St. Joseph's Children's Hospital
Hackensack, New Jersey, United States

Background: The patent ductus arteriosus (PDA) can be a significant cause of morbidity in premature infants.Historically, when pharmacologic treatment is indicated, ibuprofen or indomethacin have been used but their use is limited by potential side effects.In recent years, there has been increasing evidence to support the use of acetaminophen (AC).Intravenous AC has a broad therapeutic index, however it has the potential adverse effect of hepatotoxicity.Thus It is crucial to identify the optimal duration of treatment and avoid prolonged exposure to AC.Treatment regimens for using AC for PDA closure vary with neonatal reference guides, recommending a 3-day or 7-day course.

Objective: Our aim is to identify the optimal duration of treatment.

Design/Methods:
This was a retrospective cohort study, approved by our Institutional review board.Medical charts of all premature infants born from January 2018 to March 2022 who were treated with AC for PDA closure, were reviewed.The infants were treated with AC at the recommended dose of 15 mg/kg per dose every 6 hours for a period of 3 to 7 days.Echocardiographic findings before starting treatment and on the 3rd and 7th days were reviewed.A PDA was defined as small, moderate and large based on the 2D echo study, size and velocity of left to right shunt, color flow mapping, presence or absence of left atrial flow or left ventricular dilation and retrograde flow in the descending aorta.
Data was organized as a percentage of subjects whose PDA was effectively treated at day 7 versus those at day 3.A comparison of these proportions was analyzed by the Standard Difference (Z) test using Primer of Biostatistics software version 7 (McGraw-Hill, NY)

Results: We included 15 infants ranging from 23 to 26 weeks of gestation.They were diagnosed with a significant PDA on echocardiogram and treated with AC for 3 to 7 days depending on response.See Flowchart.Ten babies responded to treatment of which 9 showed a decrease in size that was seen after 3 days of treatment and only 1 baby who had a small PDA after 3 days showed a response after 7 days of continued treatment.The proportions of subjects whose PDA was effectively treated in 3 days versus 7 days was statistically significant (z = 2.056; p = 0.04)

Conclusion(s):
Our results are consistent with the literature that AC promotes closure of the PDA in premature infants.When effective,PDA closure or a decrease in PDA size can be seen after 3 days of treatment.Therefore, the recommended use of AC for PDA closure should be a duration of 3 days.If no response is noted by 3 days, there is no additional benefit to extend treatment for 7 days