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Namba F, Honda M, Sakatani S, Motojima Y, Kikuchi K, Sako M, Ogawa K, Mikami M, Kawada K, Fukuoka N, Ueda K. iPAPP: study protocol for a multicentre randomised controlled trial comparing safety and efficacy of intravenous paracetamol and indomethacin for the treatment of patent ductus arteriosus in preterm infants. BMJ Open 2023; 13:e069314. [PMID: 36958775 PMCID: PMC10039996 DOI: 10.1136/bmjopen-2022-069314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Patent ductus arteriosus (PDA) causes severe morbidity in premature infants. Although the use of indomethacin is the standard therapy for PDA, it is sometimes not applicable because of its adverse effects, such as renal and platelet dysfunctions. Paracetamol has emerged as an alternative to indomethacin owing to its excellent safety profile in infants. Of the recently reported case series and clinical trials on the use of paracetamol for PDA, there are few reports in Japan on paracetamol use in preterm infants. Furthermore, indications for the use of paracetamol for PDA have not been approved for use in PDA. While the safety of intravenous paracetamol therapy in case series of preterm infants treated for haemodynamically significant PDA (hsPDA) has been reported, studies which were conducted to compare paracetamol to indomethacin are limited. We, therefore, intend to investigate the hypothesis that intravenous administration of paracetamol has superior safety over indomethacin. METHODS AND ANALYSIS Multicentre open-label randomised controlled trial for intravenous administration of paracetamol for PDA in preterm infants. The inclusion criteria are (1) hsPDA, (2) gestational age from 24 to 34 weeks and birth weight (BW) from 500 to 2000 g, (3) enrolment between 24 hours and 7 days from birth and (4) obtaining parental consent. The primary outcome is renal dysfunction within 48 hours from the last dose of the study drug. Enrolled patients fulfilling all the inclusion criteria are randomly allocated to either intravenous paracetamol or intravenous indomethacin. This trial requires 110 patients. ETHICS AND DISSEMINATION The clinical trial would follow Japan's Clinical Trials Act. The trial protocol was approved by the Clinical Research Review Board of Saitama Medical University (approval number: 222001). A written informed consent would be obtained from one of the parents. The results are expected to be published in a scientific journal. TRIAL REGISTRATION NUMBER jRCTs031220386. PROTOCOL VERSION 31 March 2022, version 1.0.
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Affiliation(s)
- Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masakazu Honda
- Department of Pediatrics, Saitama Medical University Hospital, Iruma, Saitama, Japan
| | - Shun Sakatani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
- Department of Neonatology, Tokyo Metropolitan Children's Medical, Fuchu, Tokyo, Japan
| | - Yukiko Motojima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kayoko Kikuchi
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Mayumi Sako
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Kunio Ogawa
- Department of Health Policy, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Masashi Mikami
- Biostatistics Unit, Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Kou Kawada
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan
| | - Noriyasu Fukuoka
- Laboratory of Hospital Pharmacy, School of Pharmacy, Nihon University, Funabashi, Chiba, Japan
| | - Keiko Ueda
- European Clinical Research Infrastructure Network, Paris, France
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Surak A, Jain A, Hyderi A. Different approaches for patent ductus arteriosus in premature infants using acetaminophen. World J Pediatr 2022; 18:243-250. [PMID: 35253098 DOI: 10.1007/s12519-022-00526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acetaminophen use for pharmacological treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants is becoming more popular with emerging evidence that it is effective as well as safe alternative for other agents used to close hsPDA. DATA SOURCES We performed a narrative review of literature about pharmacological treatment of PDA using acetaminophen. RESULTS Acetaminophen was used as a prophylaxis, symptomatic, targeted, and a rescue approach. CONCLUSIONS It appears that acetaminophen could be used in different approaches to close the hsPDA. Long-term outcomes of acetaminophen exposure early in life still lack certainty.
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Affiliation(s)
- Aimann Surak
- Northern Alberta Neonatal Program Royal Alexandra Hospital Site NICU, DTC 5027, Stollery Children Hospital, University of Alberta, 10240 Kingsway NW, Edmonton, AB, T5H 3V9, Canada.
| | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Abbas Hyderi
- Northern Alberta Neonatal Program Royal Alexandra Hospital Site NICU, DTC 5027, Stollery Children Hospital, University of Alberta, 10240 Kingsway NW, Edmonton, AB, T5H 3V9, Canada
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