Systematic Evaluation Of Acetaminophen In The Treatment Of Symptomatic Patent Ductus Arteriosus In Premature Infants

Objective: To evaluate the efficacy and safety of acetaminophen in the treatment of symptomatic patent ductus arteriosus in premature infants.Methods: Computer was used to search the Chinese Journal of Biomedical Literature(CBM),Chinese Journal Full-text Database(CNKI),Vipu Database(VIP),Wanfang Data Knowledge Service Platform,The Cochrane Library,PubMed.All the randomized controlled trials(RCTs)at home and abroard about patients with symptomatic patent ductus arteriosus in premature infants were collected and were carried out meta-analyzes.Results: After screening,seven articles were included in the study.635 patients with patent ductus arteriosus were included.Acetaminophen versus ibuprofen in the treatment of PDA in premature infants of the total closure rate(RR = 0.99,95% CI = 0.89~1.10,P = 0.87),the first course of treatment closed rate(RR=1.03,95%CI=0.86~1.23,P=0.78),the mortality rate of the second course of treatment(RR = 0.84,95%CI=0.54 ~ 1.29,P=0.42),mortality rate(RR=0.93,95%CI=0.46~1.88,P=0.84),average medication time(MD=0.02,95%CI=-0.08~0.12,P=0.74),mean hospitalization time(SMD=-0.09,95%CI=-0.43~0.25,P=0.60),the major biochemical indexes(creatinine MD = 0.97,95% CI =-11.31~13.25,P=0.88,platelet MD = 82.71,95% CI =-0.07~165.49 P = 0.05,AST value MD = 1.00,95% CI =-1.33~3.34,P = 0.40),adverse reactions(oliguria RR=0.72,95% CI=0.25~2.07,P=0.55、abnormal renal function RR=0.99,95% CI=0.19~5.18,P=0.99、gastrointestinal bleeding RR= 0.46,95% CI=0.20~1.07,P=0.07、NEC RR=1.22,95%CI=0.57~2.61,P=0.61、high bilirubinemia RR=1.15,95%CI=0.18~7.34,P=0.88、IVH incidence RR = 0.97,95% CI = 0.52~1.80,P=0.91、ROP incidence RR = 0.63,95% CI = 0.30~1.32,P = 0.22、BPD incidence RR = 0.81,95% CI=0.35~1.87,P = 0.62,、sepsis RR = 0.91,95% CI = 0.59~1.39,P= 0.66),the difference was not statistically significant.In the acetaminophen group compared with the indomethacin control group,the total closure rate(RR=1.07,95%CI=0.95~1.20,P=0.29)、gastrointestinal bleeding(RR=1.22,95% CI=0.57~2.61,P=0.60),NEC(RR = 0.68,95% CI = 0.20~2.29,P = 0.53),renal dysfunction(RR = 0.44,95% CI = 0.02~12.31,P = 0.63),all have no statistical difference.And the incidence of oliguria was statistically significant.Conclusion: Paracetamol is an effective drug for the treatment of patent ductus arteriosus in premature infants,and there is no significant difference in the incidence of adverse reactions with nonsteroidal antiinflammatory drugs such as ibuprofen and indomethacin.Can be used as indomethacin,ibuprofen and other non-steroidal anti-inflammatory drugs or ineffective treatment of other contraindications when another conservative treatment.