Relation of shunt index with the patent ductus arteriosus among preterm infants under 30 weeks or 1500 g.

Objective: Patent ductus arteriosus is an important problem in preterms. We aimed to investigate the relation of patent ductus arteriosus with shunt index.Methods: The preterm infants with a birth weight of ≤1500 g and/or gestational age of <30 weeks and an indication for umbilical artery and venous catheterization formed the study group. Between the postnatal 24-48 hours, the first arterial and venous blood samples were obtained and the patients were evaluated by echocardiography. In patients with hemodynamically significant patent ductus arteriosus (patient group), during the first 24 hours after the competition of the first course of medical treatment, the second blood samples were obtained and echocardiography repeated. In patients without patent ductus arteriosus (control group), second blood samples were taken after the postnatal 72 hours. Also, echocardiography was performed.Results: A total of 60 infants, (female = 29, male = 31), were included in the study. We did not find a statistically significant relation between shunt index and the presence of patent ductus arteriosus (p > .05). A statistically significant positive correlation between the fraction of inspired oxygen and shunt index was found. As the postnatal ages progressed, the shunt index values tended to decrease significantly.Conclusion: Our results suggest that shunt index cannot be used as an indicator of hemodynamically significant patent ductus arteriosus in preterm infants. The postnatal age and fraction of inspired oxygen have a significant effect on shunt index in these patients. It was thought that the other possible factors that affect the shunt index should be investigated in preterms between certain postnatal ages.

Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis.

OBJECTIVES: We performed a systematic review and meta-analysis of all the available evidence to assess the efficacy and safety of paracetamol for the treatment of patent ductus arteriosus (PDA) in neonates, and to explore the effects of clinical variables on the risk of closure. DATA SOURCE: MEDLINE, Scopus and ISI Web of Knowledge databases, using the following medical subject headings and terms: paracetamol, acetaminophen and patent ductus arteriosus. Electronic and manual screening of conference abstracts from international meetings of relevant organisations. Manual search of the reference lists of all eligible articles. STUDY SELECTION: Studies comparing paracetamol versus ibuprofen, indomethacin, placebo or no intervention for the treatment of PDA. DATA EXTRACTION: Data regarding efficacy and safety were collected and analysed. RESULTS: Sixteen studies were included: 2 randomised controlled trials (RCTs) and 14 uncontrolled studies. Quality of selected studies is poor. A meta-analysis of RCTs does not demonstrate any difference in the risk of ductal closure (Mantel-Haenszel model, RR 1.07, 95% CI 0.87 to 1.33 and RR 1.03, 95% CI 0.92 to 1.16, after 3 and 6 days of treatment, respectively). Proportion meta-analysis of uncontrolled studies demonstrates a pooled ductal closure rate of 49% (95% CI 29% to 69%) and 76% (95% CI 61% to 88%) after 3 and 6 days of treatment with paracetamol, respectively. Safety profiles of paracetamol and ibuprofen are similar. CONCLUSIONS: Efficacy and safety of paracetamol appear to be comparable with those of ibuprofen. These results should be interpreted with caution, taking into account the non-optimal quality of the studies analysed and the limited number of neonates treated with paracetamol so far.