Should we definitively abandon prophylaxis for patent ductus arteriosus in preterm new-borns?

Although the prophylactic administration of indomethacin in extremely low-birth weight infants reduces the frequency of patent ductus arteriosus and severe intraventricular hemorrhage, it does not appear to provide any long-term benefit in terms of survival without neurosensory and cognitive outcomes. Considering the increased drug-induced reduction in renal, intestinal, and cerebral blood flow, the use of prophylaxis cannot be routinely recommended in preterm neonates. However, a better understanding of the genetic background of each infant may allow for individualized prophylaxis using NSAIDs and metabolomics

Comparative Study of the Efficacy of Oral and Intravenous Acetaminophen in Closure of Patent Ductus Arteriosus of Preterm Neonates

Background and Aim: Patent ductus arteriosus (PDA) is a condition in premature infants that can cause dangerous complications such as renal dysfunction, intracerebral hemorrhage, necrotizing enterocolitis, and pulmonary dysplasia. This study was conducted to compare the efficacy of oral and intravenous acetaminophen in PDA improvement in preterm infants. Methods: This randomized clinical trial study was performed on 100 children. The patients were randomly divided into two groups. Group A received intravenous acetaminophen and group B was treated with oral acetaminophen  for three consecutive days. Echocardiography was performed before and 3 and 6 days after the intervention.   Results: Before the intervention, the prevalence of a small PDA was 72% and 76% and the prevalence of a large PDA was 28% and 24%, in group A and B, respectively. The second echocardiography showed a significant PDA improvement in both groups (p<0.001). The third echocardiography showed that all patients (100%) in the oral acetaminophen were treated while only three patients (6%) in the IV acetaminophen group had a large PDA. Intravenous injection of acetaminophen significantly decreased LA/AO (Left Atrial/Aortic root diameter) ratio from 1.46 to 1.27 (p=0.043). Similarly, oral acetaminophen declined LA/AO ratio from 2.0 to 1.30 (p=0.018). At the end of the second course of treatment, the prevalence of complete cure was 100% and 94% in groups A and B, respectively. Conclusion: Oral administration of acetaminophen improved PDA treatment without any adverse effects. Therefore, IV injection of acetaminophen can be replaced with oral acetaminophen for management of PDA in preterm infants

“CIERRE ESPONTÁNEO DEL CONDUCTO ARTERIOSO EN EL PRIMER AÑO DE VIDA”

Determinar el tiempo y la probabilidad de cierre del conducto arterioso en pacientes diagnosticados al nacimiento con dicha cardiopatía, establecer porcentaje de casos que persisten con conducto arterioso antes del año de edad y determinar los factores que se asocian a la falta de cierre espontáneo en los niños portadores de conducto arterioso permeabl