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Acetaminophen administering in order to obliterate hemodynamically significant patent ductus arteriosus in neonates with extremely low birth weight


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Abstract

Background: Patent ductus arteriosus (PDA) is one of the most common pathological conditions within the neonatal period. Functioning of hemodynamically significant patent ductus arteriosus can cause a development of various complications. This is why the earliest possible drug therapy or surgery is required in order to eliminate this fetal communication. The aim: to study the efficacy and safety of acetaminophen administering to infants with low birth weight for medical obliteration of hemodynamically significant ductus arteriosus. Materials and methods: The study included 16 infants with gestational age up to 29 weeks and birth weight less than 1200 g, the average birth weight was 980±230 g and gestation was 26,4±1,4 weeks. The average age of the observable patients at the moment of the beginning of the acetaminophen therapy was 56±6 h. Ductus arteriosus diameter was 3,75±1,25 mm. All the children underwent drug obliteration of the PDA through the intravenous acetaminophen administering. 15 mg / kg of the drug was given every 6 hours for three days. The full treatment course included 12 injections. Results: The expected effect (closing of the ductus arteriosus) was achieved in 14 (87.5%) children undergoing the drug therapy. Two children with the birth weight of1000 g and 1200 g remained with the ductus arteriosus open, but the signs of the left heart volume overload decreased significantly. To achieve a clinical benefit, it took 11 injections of the drug, on average. The children with the ongoing therapy were receiving enteral nutrition with the standard dosages corresponding to their age. No complications of the urinary tract, gastrointestinal tract or haemostatic system were registered. Conclusion: Using acetaminophen for medical obliteration of the ductus arteriosus is a highly effective and safe method of treatment that has to be used in routine clinical practice. Dosing of the drug is easy to control and change, hence it is possible to cancel the drug administering as soon as the required result is achieved so as to minimize any complications.


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