ABSTRACT Objectives. A persistently patent ductus arteriosus (PDA) is a major complication of prematurity. A prompt PDA closure is crucial to reduce related risk of morbidity and mortality. Cycloxygenase inhibitors (COXi) are the a therapy of choice for PDA. However, the use of COXi is characterized by a high risk of gastrointestinal bleeding. Recently paracetamol was proposed as alternative treatment to reduce side effects of the COX-inhibitors therapy for PDA. We performed a systematic review and meta-analysis of all the available evidence to assess the risk of gastrointestinal bleeding during the treatment of PDA with paracetamol vs. COXi. Methods We conducted electronic searches in Medline, Scopus, and ISI web of Knowledge databases, using the following medical subject headings and terms: paracetamol, acetaminophen, and patent ductus arteriosus. Additionally, we performed electronic and manual screening of conference abstracts from international meetings of relevant organizations and manual search of the reference lists of all eligible articles. We considered eligible all studies comparing paracetamol vs. COXi (i.e. ibuprofen or indomethacin), or vs. placebo, for the treatment of PDA. Data regarding safety were collected and analyzed. Results Sixteen studies were included: two randomized controlled trials (RCTs) and 14 uncontrolled studies. Quality of selected studies is poor. A meta-analysis of RCT demonstrated a reduction of the risk of gastrointestinal bleeding in subjects receiving paracetamol vs. COXi (2/125 vs 9/125, RR 0.2, 0.1-1.0 95%CI). No data on gastrointestinal bleeding were reported by uncontrolled studies. Contemporarily, the meta-analysis of the data on the efficacy do not demonstrate any difference between the two therapeutic options on ductal closure (Arch Dis Child Fetal Neonatal Ed 2015; fetalneonatal-2014-307312). Conclusions The use of paracetamol may reduce the risk of gastrointestinal bleeding in preterm neonates receiving pharmacologic treatment for PDA. These results should be interpreted with caution taking into account the non-optimal quality of the studies analyzed and the limited number of neonates treated with paracetamol so far.
GASTROINTESTINAL BLEEDING ASSOCIATED WITH PHARMACOLOGIC TREATMENT OF PATENT DUCTUS ARTERIOSUS IN PRETERM NEONATES / Terrin, G; Conte, F; Oncel, My; D’Aquino, E; Cautilli, F; Monaco, S; Di Chiara, M; Mcnamara, Pj; Simons, S; Sinha, Rajeev; Erdeve, O; Tekgunduz, Ks; Dogan, M; Kessel, I; Hammerman, C; Nadir, E; Yurttutan, S; Jasani, B; Alan, S; Manguso, F; De Curtis, M.. - (2016). (Intervento presentato al convegno ESPGHAN 49th ANNUAL MEETING of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition tenutosi a Atene).
GASTROINTESTINAL BLEEDING ASSOCIATED WITH PHARMACOLOGIC TREATMENT OF PATENT DUCTUS ARTERIOSUS IN PRETERM NEONATES
Terrin G;D’Aquino E;Cautilli F;Di Chiara M;SINHA, RAJEEV;De Curtis M.
2016
Abstract
ABSTRACT Objectives. A persistently patent ductus arteriosus (PDA) is a major complication of prematurity. A prompt PDA closure is crucial to reduce related risk of morbidity and mortality. Cycloxygenase inhibitors (COXi) are the a therapy of choice for PDA. However, the use of COXi is characterized by a high risk of gastrointestinal bleeding. Recently paracetamol was proposed as alternative treatment to reduce side effects of the COX-inhibitors therapy for PDA. We performed a systematic review and meta-analysis of all the available evidence to assess the risk of gastrointestinal bleeding during the treatment of PDA with paracetamol vs. COXi. Methods We conducted electronic searches in Medline, Scopus, and ISI web of Knowledge databases, using the following medical subject headings and terms: paracetamol, acetaminophen, and patent ductus arteriosus. Additionally, we performed electronic and manual screening of conference abstracts from international meetings of relevant organizations and manual search of the reference lists of all eligible articles. We considered eligible all studies comparing paracetamol vs. COXi (i.e. ibuprofen or indomethacin), or vs. placebo, for the treatment of PDA. Data regarding safety were collected and analyzed. Results Sixteen studies were included: two randomized controlled trials (RCTs) and 14 uncontrolled studies. Quality of selected studies is poor. A meta-analysis of RCT demonstrated a reduction of the risk of gastrointestinal bleeding in subjects receiving paracetamol vs. COXi (2/125 vs 9/125, RR 0.2, 0.1-1.0 95%CI). No data on gastrointestinal bleeding were reported by uncontrolled studies. Contemporarily, the meta-analysis of the data on the efficacy do not demonstrate any difference between the two therapeutic options on ductal closure (Arch Dis Child Fetal Neonatal Ed 2015; fetalneonatal-2014-307312). Conclusions The use of paracetamol may reduce the risk of gastrointestinal bleeding in preterm neonates receiving pharmacologic treatment for PDA. These results should be interpreted with caution taking into account the non-optimal quality of the studies analyzed and the limited number of neonates treated with paracetamol so far.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
