Selahattin AKAR, Nilüfer ÇETİNER, İBRAHİM HAKAN BUCAK, Habip ALMİŞ, MEHMET TURGUT

Prematüre Bebeklerde Patent Duktus Arteriozusun Kapatılmasında Parasetamol Tedavisi İlk Seçenek Olabilir mi?

Amaç: Patent duktus arteriozusun (PDA) medikal kapatılmasında parasetamol tedavisinin güvenilirliğini ve etkinliğini değerlendirmek. Gereçler ve Yöntem: Çalışmaya hemodinamik anlamlı PDA saptanan ve ilk tedavi seçeneği olarak oral veya intravenöz parasetamol tedavisi alan 11 preterm bebek retrospektif olarak değerlendirildi.Bir kür parasetamol tedavisi 60 mg/kg/gün (4 doz, 3 gün) şeklinde uygulamıştı.Tedavi sonrası olguların ekokardiyografik ve laboratuvar bulguları değerlendirildi. Bulgular: Çalışmaya gebelik haftası 24-29 hafta arası olan 11 preterm bebek alındı. İlk kür tedavi sonrası oral parasetamol tedavisi alan 3 olgunun 2’sinde,intravenöz parasetamol tedavisi alan 8 olgunun 5’inde duktus kapanmıştı. İki kür parasetamol tedavisi sonrası oral parasetamol veya intravenöz parasetamol alan olguların tamamında duktus kapanmıştı. Tekrar açılma her iki grupta da saptanmadı. Tedavi süresince parasetamol tedavisine bağlı herhangi bir yan etki gelişmemişti. Sonuç: Oral veya intravenöz parasetamol tedavisi ucuz,kolay ulaşılabilir,etkin ve yan etkisinin az olması nedeniyle PDA’nın medikal kapatılmasında ilk seçenek olarak kullanılabilir. Ancak sonuçların genellenmesi için randomize,kontrollü çalışmalara ihtiyaç vardır.

Can Paracetamol Be Used As the First-line Treatment for Patent Ductus Arteriosus in Preterm İnfants?

Objective: To evaluate reliability and effectiveness of paracetamol therapy in medical closure of patent ductus arteriosus (PDA). Material and Methods: A total of 11 preterm infants with hemodynamically significant PDA detected who received oral or intravenous paracetamol therapy as the first line treatment were retrospectively evaluated in this study. One cure of paracetamol therapy was administered as 60 mg/kg/day (4 doses, 3 days). Post-treatment echocardiographic and laboratory findings of the subjects were assessed. Results: The study included 11 preterm infants with a gestational age of 24-29 weeks. The closure of ductus was achieved following the first cure of treatment in 2 of 3 infants administered oral paracetamol therapy and in 5 of 8 infants given intravenous paracetamol therapy. After two cures of paracetamol therapy, ductus was closed in all infants who received oral or intravenous paracetamol therapy. Re-opening was not detected in either group. No side effect was noted due to paracetamol therapy during the treatment. Conclusion: Oral or intravenous paracetamol therapy which is an inexpensive, easily accessible and effective treatment method with less side effects can be used for medical closure of PDA as the drug of first choise. In order to generalize the conclusions further randomized, controlled trials are warranted.

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