Abstract
Background: Low platelet count might promote resistance to pharmacological closure with indomethacin and ibuprofen of a hemodynamically significant patent ductus arteriosus (hsPDA). However, no studies have investigated if this occurs with paracetamol. Methods: We retrospectively assessed the correlation between platelet count, mean platelet volume (MPV), and plateletcrit (PCT), as well as the effectiveness of paracetamol in closing hsPDA in infants born at 23+0–31+6 weeks of gestation who were treated with 15 mg/kg/6 h of i.v. paracetamol for 3 days. Results: We studied 79 infants: 37 (47%) Had closure after a course of paracetamol and 42 (53%) did not. Platelet count and PCT did not correlate with paracetamol success or failure in closing hsPDA, while MPV was lower at birth (10.7 ± 1.4 vs. 9.5 ± 1.1; p < 0.001) and prior to starting therapy (11.7 ± 1.9 vs. 11.0 ± 1.6; p = 0.079) in refractory infants. Regression analysis confirmed that the low MVP measured prior to starting the treatment increased the risk of hsPDA paracetamol closure failure (OR 1.664, 95% CI 1.153–2.401). Conclusions: The greater MPV correlated positively with the effectiveness of paracetamol in closing hsPDA, while platelet count and PCT did not influence closure rates. Additional studies are needed to confirm our results.
Highlights
Published: 10 January 2022Patent ductus arteriosus (PDA) is a common disease of preterm infants who suffer from respiratory distress syndrome (RDS)
We evaluated the platelet count, mean platelet volume (MPV), and PCT (=platelet count × MPV/10.000) at birth and 24–48 h prior to starting the first course of paracetamol, since these measurements have the greatest probability of correlation with Published: January 2022Patent ductus arteriosus (PDA) response to paracetamol
Our study is the first to investigate the possible correlation between platelet count, MPV, and PCT, as well as the pharmacological effect of paracetamol in closing hemodynamically significant PDA (hsPDA) in very preterm infants
Summary
Patent ductus arteriosus (PDA) is a common disease of preterm infants who suffer from respiratory distress syndrome (RDS). There is still controversy concerning the proper management of PDA, since randomized controlled trials (RCTs) of hsPDA closure administering nonsteroidal anti-inflammatory drugs (NSAIDs) have often failed to prove significant advantages in preterm infants [2]. Infants who exhibit a persistent left-to-right shunt through the ductus arteriosus complicate RDS, they present an increased risk of respiratory failure, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and mortality [1,3,4,5,6]. Indomethacin or ibuprofen is commonly used to perform the pharmacological closure. Both of the drugs are successful in promoting ductal closure in 70–80% of cases
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