A Network Meta-Analysis of Intravenous Versus Oral Acetaminophen for Patent Ductus Arteriosus

Olowoyeye, Abiola; Nnamdi-Nwosu, Onyinye; Manalastas, Maika; Okwundu, Charles I

doi:10.1007/s00246-022-03053-1

Cited by 3 publications

(2 citation statements)

References 43 publications

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“…There is currently a dearth of RCTs directly comparing the effects of orally or intravenously administered paracetamol. A recent network meta-analysis showed that the odds ratio(OR) of oral paracetamol in closing PDA (OR = 14.18; 95% CI [4.73–42.53]) was higher than that of intravenous paracetamol (OR = 6.70; 95% CI [1.31–34.33]) among preterm infants compared with the placebo group, indicating that oral paracetamol outperformed intravenous paracetamol to close PDA ( Olowoyeye et al, 2022 ). Nonetheless, only two retrospective studies have hitherto compared the efficacy of oral and intravenous paracetamol to close hsPDA in preterm infants ( Gover et al, 2022 ; Sancak et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis

Luo,

He,

et al. 2024

PeerJ

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Background This systematic review and meta-analysis aims to explore the potential impact of the route of administration on the efficacy of therapies and occurrence of adverse events when administering medications to premature infants with patent ductus arteriosus (PDA). Method The protocol for this review has been registered with PROSPERO (CRD 42022324598). We searched relevant studies in PubMed, Embase, Cochrane, and the Web of Science databases from March 26, 1996, to January 31, 2022. Results A total of six randomized controlled trials (RCTs) and five observational studies were included for analysis, involving 630 premature neonates in total. Among these infants, 480 were in the ibuprofen group (oral vs. intravenous routes), 78 in the paracetamol group (oral vs. intravenous routes), and 72 in the ibuprofen group (rectal vs. oral routes). Our meta-analysis revealed a significant difference in the rate of PDA closure between the the initial course of oral ibuprofen and intravenous ibuprofen groups (relative risk (RR) = 1.27, 95% confidence interval (CI) [1.13–1.44]; P < 0.0001, I2 = 0%). In contrast, the meta-analysis of paracetamol administration via oral versus intravenous routes showed no significant difference in PDA closure rates (RR = 0.86, 95% CI [0.38–1.91]; P = 0.71, I2 = 76%). However, there was no statistically significant difference in the risk of adverse events or the need for surgical intervention among various drug administration methods after the complete course of drug therapy. Conclusion This meta-analysis evaluated the safety and effectiveness of different medication routes for treating PDA in premature infants. Our analysis results revealed that compared with intravenous administration, oral ibuprofen may offer certain advantages in closing PDA without increasing the risk of adverse events. Conversely, the use of paracetamol demonstrated no significant difference in PDA closure and the risk of adverse events between oral and intravenous administration.

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Section: Discussionmentioning

confidence: 99%

The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis

Luo,

He,

et al. 2024

PeerJ

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“…The main reason for applying a conservative approach is that spontaneous permanent DA closure occurs in >34% of ELBW neonates [32]. In preterm infants with the deterioration of respiratory status due to hemodynamically significant PDA, ductus arteriosus closure might be attempted through prostaglandin production inhibition by the administration of COX inhibitors (ibuprofen or indomethacin) [33]. In addition, the Japanese guidelines recommend surgical ligation for PDA upon unsuccessful water restriction and/or administration of COX inhibitors [10,12].…”

Section: Discussionmentioning

confidence: 99%

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

Kikuchi,

Goto,

Katsumata

et al. 2024

JCDD

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In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011–2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson’s correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the “posture/motor” sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis.

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Recommitting to Rules of Evidence and Laws of Inference

Benitz,

Polin

2024

The Journal of Pediatrics

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A Network Meta-Analysis of Intravenous Versus Oral Acetaminophen for Patent Ductus Arteriosus

Cited by 3 publications

References 43 publications

The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis

The impact of the route of administration on the efficacy and safety of the drug therapy for patent ductus arteriosus in premature infants: a systematic review and meta-analysis

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

Recommitting to Rules of Evidence and Laws of Inference

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