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

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.

• Authors: Sally Mashally, Lynne E Nield, Patrick J McNamara, Fernando F Martins, Afif El-Khuffash, Amish Jain, Dany E Weisz
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 156 Issue 5 Pg. 1937-1944 (11 2018) ISSN: 1097-685X [Electronic] United States
• PMID: 30007780 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Chemical References

• Acetaminophen

Topics

• Acetaminophen (administration & dosage, adverse effects)
• Administration, Oral
• Cardiac Surgical Procedures (adverse effects, methods, mortality)
• Chronic Disease
• Clinical Decision-Making
• Drug Administration Schedule
• Ductus Arteriosus, Patent (diagnostic imaging, mortality, therapy)
• Female
• Gestational Age
• Humans
• Infant, Newborn
• Infant, Premature
• Ligation
• Lung Diseases (etiology)
• Male
• Retrospective Studies
• Risk Factors
• Time Factors
• Time-to-Treatment
• Treatment Outcome