title: Acetaminophen to avoid surgical ligation in extremely low gestational age neonates with persistent hemodynamically significant patent ductus arteriosus.
abstract: The objective of this study was to evaluate the effectiveness of rescue oral acetaminophen in improving echocardiography (echo) indices of patent ductus arteriosus (PDA) shunt volume and avoiding surgical ligation in extremely low gestational age (GA) neonates (ELGANs, <28 weeks) with persistent PDA.
  
  
  
  Retrospective cohort study of ELGANs with moderate or severe PDA at risk for ligation after a practice change introducing oral acetaminophen (60 mg kg(-1) day(-1) for 3 to 7 days) to facilitate ductal constriction after indomethacin failure.
  
  
  
  Twenty-six infants (median GA 24.4 weeks at birth) with persistent PDA under consideration for surgical ligation were treated with oral acetaminophen at a mean of 27 days of life. Echo indices of shunt volume improved in 12 (46%) infants (3 closed and 9 reduced to mild shunt), all of whom avoided ligation. There was no echo improvement in 14 (54%) infants, of which 8/14 underwent ligation, and ligation was deferred in 6/14 infants, mostly owing to improvement in respiratory stability. Fewer responders than non-responders underwent ligation (0% vs 57%, P<0.01), though there were no differences in other neonatal outcomes.
  
  
  
  In ELGANs with persistent significant PDA, rescue therapy with oral acetaminophen was associated with improvement in echo indices of shunt volume and avoidance of ligation in nearly half of infants.
authors.affiliation: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: D E
authors.initials: DE
authors.lastname: Weisz
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: F F
authors.initials: FF
authors.lastname: Martins
authors.affiliation: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: L E
authors.initials: LE
authors.lastname: Nield
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.|School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: El-Khuffash
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Department of Paediatrics, Mt Sinai Hospital, Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada.|Physiology and Experimental Medicine Program, SickKids Research Institute, Toronto, ON, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: McNamara
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D002170:Canada; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D016861:Cyclooxygenase Inhibitors; D000082:Acetaminophen