Early closure mechanisms of the ductus arteriosus in immature infants
| Autor: | Jean-Marc Treluyer, Outi Aikio, Jean-Christophe Rozé, Mikko Hallman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
congenital
hereditary and neonatal diseases and abnormalities medicine.drug_class medicine.medical_treatment Indomethacin Ischemia Ibuprofen medicine.disease_cause 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Ductus arteriosus medicine Humans cardiovascular diseases 030212 general & internal medicine Adverse effect Ductus Arteriosus Patent business.industry organic chemicals Infant Newborn Infant Ductus Arteriosus General Medicine medicine.disease Acetaminophen medicine.anatomical_structure Anesthesia Pediatrics Perinatology and Child Health cardiovascular system Corticosteroid business Infant Premature Oxidative stress medicine.drug Prostaglandin E |
| Zdroj: | Acta Paediatrica. 110:1995-2007 |
| ISSN: | 1651-2227 0803-5253 |
| DOI: | 10.1111/apa.15826 |
| Popis: | Aim According to experimental studies, cardiopulmonary distress decreases after closure of patent ductus arteriosus. However, early closure of the ductus using ibuprofen or indomethacin has failed to increase survival without serious morbidity. We review relevant data aiming to define optimal early management strategies that promote early closure of ductus arteriosus without serious adverse effects. Methods Literature in English was searched selectively focusing on the potential of using acetaminophen for early closure of the ductus. Results Prophylactic ibuprofen or indomethacin intended to close the ductus, predisposes infants to ischaemia, bleeding and immune dysfunction. Acetaminophen appears to have a similar efficacy as indomethacin or ibuprofen, and all three dose-dependently constrict the ductus. Ibuprofen and indomethacin cause non-specific inhibition of prostaglandin synthesis, while acetaminophen predominantly inhibits prostaglandin E synthesis. Owing to low CYP450 activity in infancy, acetaminophen toxicity has been rarely evident. However, increasing the dosage increases the oxidative stress. We review prophylactic treatments that may increase the safety and efficacy of acetaminophen. These include vitamin A, cysteine and glutamine, and low-dose corticosteroid supplementation. Conclusion The current challenge is to define a safe perinatal management practice that promotes cardiorespiratory adaptation in immature infants, particularly the seamless closure of the ductus before significant cardiopulmonary distress develops. |
| Databáze: | OpenAIRE |
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