Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Emerging data indicate that acetaminophen may adversely affect lung health. We examined whether acetaminophen compared with cyclooxygenase (COX) inhibitor alone for patent ductus arteriosus (PDA) is associated with mortality or respiratory morbidity in extremely preterm infants. METHODS: This is a retrospective cohort study using data from the National Institute of Child Health and Human Development Neonatal Research Network. Infants were born at 22 to 28 weeks' gestation or weighing 401 to 1000 g between 2016 and 2020 and received acetaminophen, ibuprofen, and/or indomethacin for PDA closure. The primary outcome was death or grade 2 to 3 bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age. Secondary outcomes included predischarge mortality and respiratory morbidities. Risk ratios were adjusted for baseline and early postnatal factors. Additional exploratory analyses were adjusted for later postnatal covariates. RESULTS: Of 1921 infants, 627 (32.6%) received acetaminophen and 1294 (67.3%) received COX inhibitor only. Multidrug therapy (42.9% vs 4.7%) and surgical or catheter PDA closure (26.5% vs 19.9%) were more common among acetaminophen-exposed infants. Death or grade 2 to 3 BPD at 36 weeks' postmenstrual age was similar between infants treated with acetaminophen versus COX inhibitor only (57.1% vs 58.3%; adjusted relative risk [aRR] 0.96, 95% confidence interval [CI] 0.87-1.06). Acetaminophen was associated with increased risk of predischarge mortality (13.3% vs 10.0%) when adjusting for perinatal and early postnatal factors (aRR 1.42, 95% CI 1.02-1.93), but not in exploratory analyses that included later postnatal factors (aRR 1.28, 95% CI 0.91-1.82). CONCLUSIONS: Treatment with acetaminophen versus COX inhibitor alone for PDA was not associated with the composite outcome of death or BPD in extremely preterm infants. Our results support further evaluation of whether acetaminophen for PDA increases mortality.
Source: PEDIATRICS
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Brown University, Ohio State University, Emory University, Cincinnati Children's Hospital Medical Center, Nationwide Children's Hospital, Case Western Reserve University, East Carolina University, Children's Mercy Hospital, Children's Healthcare of Atlanta, University of Texas Health Science Center at Houston, McGovern Medical School, Southwest Hospital, National Institutes of Health, School of Medicine, Duke University, Research Institute, Nationwide Children's Hospital, National Heart, Lung, and Blood Institute, National Institute of Child Health and Human Development, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1029946750, Rochester-Buffalo Neonatal Research Group, NICHD Cooperative Multicenter Neonatal Research Network, Duke CTSA (Composite), NICHD Neonatal Research Network (NRN), Cooperative Multicenter Neonatal Research Network, G3558224168, One Center, Two States, Microbiome of the Airway and the Risk for Bronchopulmonary Dysplasia in the Lungs of Extreme Preterms: The MARBLE Study, Cooperative Multicenter Network of Neonatal Intensive Care Units, NICHD Cooperative Multicenter Neonatal Research Network, Multicenter Network of Neonatal Intensive Care Units, Neonatal Research Network Data Coordinating Center (DCC), Atlanta Clinical and Translational Science Institute (ACTSI) Renewal, Eunice Kennedy Shriver NICHD Cooperative Multicenter Neonatal Research Network, NICHD Neonatal Research Network, Multicenter Network of Neonatal Intensive Care Units-University of Texas at Houston (UT Houston) Clinical Center, Development and evaluation of a risk-based approach to target vitamin A therapy to prevent bronchopulmonary dysplasia among very low birth weight infants, Data Ctr for the Cooperative Neonatal Research Network, NICHD Neonatal Research Network Clinical Center UAB, NICHD Cooperative Multicenter Neonatal Research Network - Utah Center, Neonatal Research Network Data Coordinating Center (DCC) 2023-2028, NICHD Neonatal Research Network -- Cincinnati Clinical Center, Pulmonary implications of perinatal acetaminophen exposure, Multidimensional phenotype classification in grade 3 BPD, NICHD Neonatal Research Network - Stanford University, NICHD Neonatal Research Network Clinical Center - Case Western Reserve University, NICHD Neonatal Research Network, Eunice Kennedy Shriver NICHD Cooperative Multicenter Neonatal ResearchNetwork, Clinical Center for NICHD/Neonatal Research Network, NICHD COPPERATIVE MULTICENTER NEONATAL RESEARCH NETWORK, NICHD Cooperative Multicenter Neonatal Research Network, North Carolina Clinical Center, NICHD Neonatal Research Network (NRN): Clinical Centers (UG1 Clinical Trial Optional
OpenAlex ID: W4400693136