Selahattin AKAR, Veysi ALMAZ, Mehmet TURGUT

Postnatal 38. Günde Oral Parasetamol Tedavisiyle Kapanan Hemodinamik Anlamlı Patent Duktus Arteriosus Olgusu

Patent duktus arteriosus özellikle küçük prematürelerin önemli sorunlarından biridir. 25 gebelik haftasında 515 gr ağırlığında doğan prematüre bebek yenidoğan servisine yatırıldı. Respiratuvar distres sendromu (RDS) nedeniyle iki kez surfaktan tedavisi uygulanan hastanın postnatal 25. günde hemodinamik anlamlı patent duktus arteriosus (PDA) saptanması nedeniyle hastaya 2 kür oral ibuprofen tedavisi verildi. İbuprofen sonrası duktusu kapanan hastanın postnatal 38. günde klinik ve laboratuvar olarak sepsis gelişen hastanın ekokardiyografisinde (EKO) duktusunun açıldığı ve hemodinamik anlamlı olduğu saptandı. Trombositopenisi olması nedeniyle hastaya medikal kapatma tedavisi olarak oral parasetamol başlandı. Oral parasetamol tedavisi sonrası kontrol EKO’sunda PDA’nın kapandığı görüldü. Klinik izleminde hastanın genel durumu iyi seyretti. Postnatal 110. günde 2120 grama ulaşan hasta yenidoğan polikliniğine kontrole gelmek üzere taburcu edildi. Sonuç olarak ibuprofen tedavisine yanıt vermeyen ya da ibuprofen tedavisinin kontrendike olduğu durumlarda geç dönemde de parasetamol tedavisi alternatif seçenek olabilir.

A Hemodynamically Significant Patent Ductus Arteriosus Case which was Closed at 38th Day with Oral Paracetamol Therapy

Patent ductus arteriosus is one of the important problem in premature infants. A premature infant weighed 515 g at 25th week of gestation was admitted in the neonatal intensive care unit. The patient administered surfactant therapy two times for respiratory distress syndrome (RDS) was given 2 cure of oral ibuprofen therapy due to hemodynamically significant patent ductus arteriosus (PDA) detected. Echocardiography of the patient whom ductus was closed after ibuprofen therapy and who clinically and laboratorially developed sepsis at the 38th postnatal day revealed that the ductus was hemodynamically significantly open. Upon the patient had thrombocytopenia, oral paracetamol therapy was initiated as medical closure treatment. After the treatment, control ECHO showed a closed PDA. General status of the patient was normal during the follow-up. The patient reached to 2,120 g at the 110th postnatal day, and was discharged to home with outpatient clinic control plan. In conclusion, paracetamol treatment may be an alternative option also in late periods in the cases of unresponsiveness to ibuprofen or a contraindication for this agent.

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1. Gregoire N, Gualano V, Geneteau A, et al. Population pharmacokinetics of ibuprofen enantiomers in very premature neonates. J Clin Pharmacol 2004; 44:1114-1124.
2. Mahony L, Caldwell RL, Girod DA, et al.Indomethacin therapy on the first day of life in infants with very low birth weight. J Pediatr 1985;106:801-805.
3. Bagnoli F, Rossetti A, Messina G, Mori A, Casucci M, Tomasini B. Treatment of patent ductus arteriosus (PDA) using ibuprofen: renal side-effects in VLBW and ELBW newborns. J Matern Fetal Neonatal Med. 2013;26(4):423–429.
4. Akima S, Kent A, Reynolds GJ, Gallagher M, Falk MC. Indomethacin and renal impairment in neonates. Pediatr Nephrol 2004;19(5):490–493.
5. Kanmaz G, Erdeve O, Canpolat FE, Oğuz SS, Uras N, Altug N, Greijdanus B, Dilmen U. Serum ibuprofen levels of extremely preterm infants treated prophylactically with oral ibuprofen to prevent patent ductus arteriosus. Eur J Clin Pharmacol 2013;69(5):1075–1081.
6. Fujii AM, Brown E, Mirochnick M, O’Brien S, Kaufman G. Neonatal necrotizing enterocolitis with intestinal perforation in extremely premature infants receiving early indomethacin treatment for patent ductus arteriosus. J Perinatol 2002;22(7):535– 540.
7. Olukman O, Calkavur S, Ercan G, Atlihan F, Oner T, Tavli V, Kultursay N. Comparison of oral and intravenous Ibuprofen for medical closure of patent ductus arteriosus: which one is better? Congenit Heart Dis.2012;7(6):534-43.
8. Erdeve O, Yurttutan S, Altug N, Ozdemir R, Gokmen T, Dilmen U, Oguz SS, Uras N. Oral versus intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2012;97(4):F279-83.
9. Jasani B, Kabra N, Nanavati R. Oral paracetamol in treatment of closure of patent ductus arteriosus in preterm neonates. J Postgrad Med 2013;59:312–14.
10. Sancak S, Gokmen Yildirim T, Topcuoglu S, Yavuz T, Karatekin G, Ovali F. Oral versus intravenous paracetamol: which is better in closure of patent ductus arteriosus in very low birth weight infants? J Matern Fetal Neonatal Med 2014;23:1-5.
11. Hammerman C, Bin-Nun A, Markovitch E, et al. Ductal closure with paracetamol: a surprising new approach to patent ductus arteriosus treatment. Pediatrics 2011;128:e1618–21.
12. Bagnoli F, Rossetti A, Messina G, Mori A, Casucci M, Tomasini B:Treatment of patent ductus arteriosus (PDA) using ibuprofen: renal side-effects in VLBW and ELBW newborns. J Matern Fetal Neonatal Med 2013;26(4):423–429.,
13. Erdeve O, Sarici SU, Sari E, Gok F:Oral-ibuprofen-induced acute renal failure in a preterm infant. Pediatr Nephrol 2008;23(9):1565–1567.,
14. Memisoglu A, Alp Ünkar Z, Cetiner N, Akalın F, Ozdemir H, Bilgen HS, Ozek E.Ductal closure with intravenous paracetamol: a new approach to patent ductus arteriosus treatment. J Matern Fetal Neonatal Med. 2016;29(6):987-990.
15. Oncel MY, Yurttutan S, Uras N, et al. An alternative drug (paracetamol) in ibuprofen resistant or contraindicated preterm infants.Arch Dis Child Fetal Neonatal Ed 2013;98:F94–5.
16. Clyman RI. Mechanisms regulating the ductus arteriosus. Biol Neonate 2006;89:330–5.
17. Dang D, Wang D, Zhang C, et al. Comparison of oral paracetamol versus ibuprofen in premature infants with patent ductus arteriosus:a randomized controlled trial. PLoS One 2013;8:e77888.
18. Oncel MY, Yurttutan S, Erdeve O, et al. Oral paracetamol versus oral ibuprofen in the management of patent ductus arteriosus in preterm infants. A randomized controlled trial. J Pediatr 2014;164:510–14.
19. Graham GG, Davies MJ, Day RO, Mohamudally A, Scott KF:The modern pharmacology of paracetamol: therapeutic actions, mechanism of action,metabolism, toxicity and recent pharmacological findings.Inflammopharmacol 2013;21(3):201–232.
20. Echtler K, Stark K, Lorenz M, Kerstan S, Walch A, Jennen L, Rudelius M, Seidl S,Kremmer E, Emambokus NR, von Bruehl ML, Frampton J, Isermann B,Genzel Boroviczény O, Schreiber C, Mehilli J, Kastrati A, Schwaiger M,Shivdasani RA, Massberg S:Platelets contribute to postnatal occlusion of theductus arteriosus.Nat Med 2010;16(1):75–82.
21. Clyman R, Chemtob S:Vessel remodeling in the newborn: platelets fill the gap.Nat Med 2010;16(1):33–35.
22. Gonzalez A, Sosenko IRS, Chandar J, et al. Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighting 1000 grams or less. J Pediatr 1996;128(4):474-478.
23. Yurttutan S, Oncel MY, Arayıcı S, et al. A different first-choice drug in the management of patent ductus arteriosus: oral paracetamol. J Matern Fetal Neonatal Med 2013;26:825–827.
24. Oncel MY, Yurttutan S, Degirmencioglu H, et al. Intravenous paracetamol treatment in the management of patent ductus arteriosus in extremely low birth weight infants. Neonatology 2013;103:166–169.
25. Tekgündüz KŞ, Ceviz N, Caner İ, Olgun H, Demirelli Y, Yolcu C, Şahin İO, Kara M. Intravenous paracetamol with a lower dose is also effective for the treatment of patent ductus arteriosus in pre-term infants. Cardiol Young 2015;25(6):10601064.
26. Roofthooft DW, van Beynum IM, Helbing WA, Reiss IK, Simons SH: Paracetamol for ductus arteriosus closure: not always a success story.Neonatology 2013;104(3):170.