Drug exposure for PDA closure in France: a prospective, cohort-based, analysis

Iacobelli, Simona; Lorrain, S.; Gouyon, Béatrice; Gambacorta, Silvia; Laforgia, Nicola; Gouyon, Jean‐Bernard; Bonsante, Francesco

doi:10.1007/s00228-020-02974-1

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…These data underscore the prevalent reliance on furosemide as a therapeutic option in the management of conditions affecting preterm infants in NICUs. Based on previous studies, primarily animal models, it was demonstrated that the impact of furosemide on the production of PGE2 in the cortical portion of the thick ascending limb of the loop of Henle is dose-dependent [19]. Given that PGE2 has been shown to delay the closure of DA [20,21], it can be hypothesized that in VLBW preterm infants, a higher cumulative dose of furosemide could lead to increased renal production of PGE2, thereby extending the time to spontaneously close DA.…”

Section: Discussionmentioning

confidence: 99%

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Furosemide and Ductus Arteriosus Closure in Very-Low-Birth-Weight Preterm Infants: A Comprehensive Retrospective Study

Kuo,

Su,

Yang

et al. 2024

Children

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Ductus arteriosus closure may be delayed in preterm infants, and prostaglandin, a vasodilator, can affect ductal patency. Furosemide can increase renal prostaglandin synthesis, so its net effect on patent ductus arteriosus (PDA) is uncertain. Our goal is to explore the relationship between furosemide and spontaneous ductal closure in very-low-birth-weight preterm infants. Our treatment for PDA involves fluid restriction initially and furosemide administration for hemodynamically significant PDA until closure is confirmed by the echocardiogram. We enrolled 105 infants from 1 January 2019 to 30 June 2022 and evaluated the impact of furosemide on ductal closure, including exposure duration and cumulative dose. There is no correlation between furosemide exposure and spontaneous ductal closure (p = 0.384). Furosemide exposure does not delay the postmenstrual age at which spontaneous ductal closure occurs (p = 0.558). The time for spontaneous ductal closure is positively associated with furosemide prescription days (coefficient value = 0.547, p = 0.026) and negatively with gestational age (coefficient value = −0.384, p = 0.062). The prescription of furosemide does not impact the probability or time duration of ductus arteriosus spontaneous closure. The cumulative dose of furosemide has minimal impact on ductal closure. The correlation between furosemide exposure duration and ductal patency duration is likely due to our treatment protocol, with gestational age being a significant factor.

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Section: Discussionmentioning

confidence: 99%

“…During the waiting period, furosemide is commonly used to reduce pulmonary edema caused by PDA shunting. Furosemide is commonly administered to as many as 50% of hospitalized preterm infants [18], and one study reported that over 24% of infants with hsPDA were exposed to furosemide at some point [19].…”

Section: Introductionmentioning

confidence: 99%

Furosemide and Ductus Arteriosus Closure in Very-Low-Birth-Weight Preterm Infants: A Comprehensive Retrospective Study

Kuo,

Su,

Yang

et al. 2024

Children

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“…paracetamol IV e encontraram necessidade reduzida de administração de ibuprofeno subsequente ou intervenção cirúrgica quando comparada com a do grupo controle. Iacobelli et al (2020) evidenciaram que o tratamento de PCA-HS antes de 48h de vida e paracetamol dado como tratamento de primeira linha estavam associados à diminuição da reabertura do CA. Roofthooft et al (2015) atestaram que a administração do paracetamol IV tardio reduziu consideravelmente o sucesso do tratamento.…”

Section: Discussionunclassified

“…Ao comparar o uso de paracetamol (VO ou IV) com o de ibuprofeno (VO ou IV), Ohlsson e Shah (2020) relataram dados relacionados à necessidade de suplementação de oxigênio, ocorrência de hemorragia gastrointestinal e níveis séricos de creatinina e bilirrubina, todos menores ou ausentes no grupo paracetamol; enquanto a contagem de plaquetas e a saída de urina foram predominantes após o uso de paracetamol em relação ao ibuprofeno. Iacobelli et al (2020) demonstraram que a administração do paracetamol associou-se à necessidade de doses mais baixas de furosemida, se comparado ao ibuprofeno. Tauber et al (2020) avaliaram o estresse cardíaco, medido pelo nível de BNP, em grupos submetidos à terapia medicamentosa com ibuprofeno IV e paracetamol IV.…”

Section: Discussionunclassified

Use of paracetamol for the treatment of patent ductus arteriosus in premature Newborns: A systematic review

Resende

Reis²,

Minucci³

et al. 2022

RSD

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Objective: Patent ductus arteriosus is associated with multiple complications and high neonatal mortality. This study aimed to evaluate the efficacy and benefits of paracetamol compared to ibuprofen and indomethacin, non-steroidal anti-inflammatory drugs usually used to close the ductus arteriosus in premature newborns. Data source: We searched the PubMed, SciELO, Lilacs, Bireme, ClinicalTrials.gov and Embase databases for articles published between January 2005 and December 2020. The descriptors used were: premature newborn, patent ductus arteriosus, pharmacotherapy, closure and paracetamol / acetaminophen. The quality of the articles was evaluated by the classification of the Oxford Centre for Evidence based Medicine. Data synthesis: The efficacy of paracetamol is comparable to that of ibuprofen and indomethacin, and it is associated with lower rates of gastrointestinal and intracerebral hemorrhage, spontaneous intestinal perforation, thrombocytopenia, hepatic and renal intolerance, and lower serum values of urea, creatinine, and bilirubin. Furthermore, it is more advantageous than placebo or nonintervention and may be the best option in cases with contraindications for other drugs. Gestational age and birth weight were factors that influenced the efficacy of paracetamol and showed reduced efficacy in extremely premature newborns with extremely low and very low birth weights. Conclusions: Other clinical and prospective studies are needed to support the indication of paracetamol in patent ductus arteriosus. However, this drug proves to be a promising pharmacological alternative, having similar efficacy to classic non-steroidal anti-inflammatory drugs, with fewer adverse effects.

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“…19 A large French study showed that in 2017-2018, APAP was used as the first-line agent in 10.5% of those treated for PDA, with an average gestational age of 26.4 AE 1.8 weeks. 20 These data demonstrate that APAP is firmly established as a therapeutic option for a condition that disproportionately affects the most immature and vulnerable patients.…”

mentioning

confidence: 82%

Acetaminophen and the Developing Lung: Could There Be Lifelong Consequences?

Wright

2021

The Journal of Pediatrics

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he use of acetaminophen (paracetamol, APAP) in the neonatal intensive care unit (NICU) has become ubiquitous. Between 2005 and 2010, APAP was the 15th most common pharmacologic exposure among infants admitted to the Pediatrix-affiliated NICUs in the US. 1 Over nearly the same period of time, a significant increase in the use of APAP was reported in German NICUs, occurring in 8.1% of all infants with very low birth weights by 2010. 2 Since 2010, multiple reports indicate increasing APAP use in NI-CUs around the world. Data gathered in 2017-2018 from nearly 30 000 French infants showed that APAP was the third most commonly administered medication behind vitamin K and vitamin D and was given to >65% of all infants born at less than 27 weeks of gestation. 3 It is likely that this rapid increase in APAP exposure is primarily driven by the desire to provide analgesia and limit opioid exposure. In fact, one French NICU reported that by 2012-2013, nearly 95% of patients in the NICU postsurgery were administered APAP. 4 These data have been interpreted as demonstrating that "paracetamol is somehow a 'rising star' in NICU pain management." 5 The introduction of APAP into the NICU led to the chance observation that administration was temporally associated with closure of the patent ductus arteriosus (PDA). 6 In the time since this case series was published in 2011, the rise in annual publications in PubMed.gov demonstrate the rapidly growing interest in this pharmacologic approach to PDA treatment (Figure 1). Multiple case series, cohort studies, and ultimately randomized controlled trials (RCTs) evaluating APAP for PDA followed, and these have been summarized in a number of comprehensive reviews. [7][8][9][10][11][12][13] Based on the available data, a 2020 Cochrane review by Ohlsson and Shah concluded that moderate-quality evidence demonstrated that APAP is as effective as ibuprofen to treat PDA. 14 However, this review also noted that the results from the more than 19 registered and ongoing trials are necessary before any "recommendations for the possible routine use of paracetamol in the newborn population can be made." Specifically, the paucity of data

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Drug exposure for PDA closure in France: a prospective, cohort-based, analysis

Cited by 10 publications

References 17 publications

Furosemide and Ductus Arteriosus Closure in Very-Low-Birth-Weight Preterm Infants: A Comprehensive Retrospective Study

Furosemide and Ductus Arteriosus Closure in Very-Low-Birth-Weight Preterm Infants: A Comprehensive Retrospective Study

Use of paracetamol for the treatment of patent ductus arteriosus in premature Newborns: A systematic review

Acetaminophen and the Developing Lung: Could There Be Lifelong Consequences?

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