Inflammatory biomarkers in very preterm infants during early intravenous paracetamol administration

Aikio, Outi; Härmä, Antti; Härkin, Pia; Leskinen, Markku; Valkama, Marita; Saarela, Timo; Salminen, Annamari; Hallman, Mikko

doi:10.1016/j.earlhumdev.2021.105464

Cited by 2 publications

(1 citation statement)

References 46 publications

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“…The phase 2 trials using paracetamol and other trials mostly after the 1st week revealed no adverse effects. In one early trial, paracetamol tended to decrease the early hemodynamic stress due to PDA closure ( 112 ), and it decreased the levels of C-reactive proteins, suggesting moderation of inflammation ( 113 ).…”

Section: Management Of Transitional Circulationmentioning

confidence: 99%

Management Practices During Perinatal Respiratory Transition of Very Premature Infants

et al. 2022

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The present review considers some controversial management practices during extremely premature perinatal transition. We focus on perinatal prevention and treatment of respiratory distress syndrome (RDS) in immature infants. New concerns regarding antenatal corticosteroid management have been raised. Many fetuses are only exposed to potential adverse effects of the drug. Hence, the formulation and the dosage may need to be modified. Another challenge is to increase the fraction of the high-risk fetuses that benefit from the drug and to minimize the harmful effects of the drug. On the other hand, boosting anti-inflammatory and anti-microbial properties of surfactant requires further attention. Techniques of prophylactic surfactant administration to extremely immature infants at birth may be further refined. Also, new findings suggest that prophylactic treatment of patent ductus arteriosus (PDA) of a high-risk population rather than later selective closure of PDA may be preferred. The TREOCAPA trial (Prophylactic treatment of the ductus arteriosus in preterm infants by acetaminophen) evaluates, whether early intravenous paracetamol decreases the serious cardiorespiratory consequences following extremely premature birth. Lastly, is inhaled nitric oxide (iNO) used in excess? According to current evidence, iNO treatment of uncomplicated RDS is not indicated. Considerably less than 10% of all very premature infants are affected by early persistence of pulmonary hypertension (PPHN). According to observational studies, effective ventilation combined with early iNO treatment are effective in management of this previously fatal disease. PPHN is associated with prolonged rupture of fetal membranes and birth asphyxia. The lipopolysaccharide (LPS)-induced immunotolerance and hypoxia-reperfusion-induced oxidant stress may inactivate NO-synthetases in pulmonary arterioles and terminal airways. Prospective trials on iNO in the management of PPHN are indicated. Other pulmonary vasodilators may be considered as comparison drugs or adjunctive drugs. The multidisciplinary challenge is to understand the regulation of pregnancy duration and the factors participating the onset of extremely premature preterm deliveries and respiratory adaptation. Basic research aims to identify deficiencies in maternal and fetal tissues that predispose to very preterm births and deteriorate the respiratory adaptation of immature infants. Better understanding on causes and prevention of extremely preterm births would eventually provide effective antenatal and neonatal management practices required for the intact survival.

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Section: Management Of Transitional Circulationmentioning

confidence: 99%

Management Practices During Perinatal Respiratory Transition of Very Premature Infants

et al. 2022

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Blood pressure increase preceded spontaneous and paracetamol‐induced, early ductal closure in very preterm infants

Ukkonen,

Härkin,

Härmä

et al. 2024

Acta Paediatrica

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AimTo investigate the blood pressure (BP) and ductal calibre patterns associated with early ductal closure in very low gestational age (<32 weeks) infants.MethodsBlood pressure was continuously measured intra‐arterially among 43 infants participating in a randomised, double‐blind trial of 4 days prophylactic intravenous paracetamol. Early closure of the ductus was verified by daily ultrasound examinations. The BP recordings, before and after the verified ductal closure, were examined and compared to control infants without ductal closure. In the 24‐h preceding the ultrasound‐verified ductal closure, periods of increased BP were searched and identified as suggestive ductal closure time points. In control infants without ductal closure, BP trends were examined during the corresponding age.ResultsMean arterial BP increased significantly before ductal closure (p < 0.001) and stayed higher than in the control group. Mean BP during the 8 h preceding closure significantly predicted the ductal closure [OR 2.094 (95% CI 1.209–3.630), p = 0.008], and multiple potential confounders failed to abolish this association. A linear decrease pattern in ductal calibre was significantly associated with the ductal closure.ConclusionBlood pressure increased and stabilised before the early ductal closure, offering potential implications on treatment strategies of very premature infants.

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Inflammatory biomarkers in very preterm infants during early intravenous paracetamol administration

Cited by 2 publications

References 46 publications

Management Practices During Perinatal Respiratory Transition of Very Premature Infants

Management Practices During Perinatal Respiratory Transition of Very Premature Infants

Blood pressure increase preceded spontaneous and paracetamol‐induced, early ductal closure in very preterm infants

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