196 - Factors Associated with Failure of Response to Tylenol Therapy in Preterm Infants with PDA

Publication Number: 196.4844

Kayla Adams, Southern Illinois University School of Medicine, Springfield, IL, United States; Venkata S. Majjiga, SIU School of Medicine, Chatham, IL, United States; Urav K. Shah, HSHS St Johns Children's Hospital, Springfield, IL, United States; Virginia Kreckman, Southern Illinois University School of Medicine, Springfield, IL, United States; Erin M. Bauer, Southern Illinois University School of Medicine, Springfield, IL, United States; Brooke Seacrist, Southern Illinois University School of Medicine, Springfield, IL, United States; Sean McGinity, Southern Illinois University School of Medicine, Springfield, IL, United States; Mohamed F. Ahamed, SIU Medicine, Springfield, IL, United States

Background: Patent ductus arteriosus (PDA) in premature infants (40-68% incidence) with higher rates in those < 28 weeks gestation is associated with increased rates of other comorbidities. Acetaminophen has been used to treatment PDA with a success rate of 30-45% in extremely preterm infants and ~60% overall success rate. However, factors associated with failure of acetaminophen for PDA closure have not been well documented.

Objective: To determine the factors associated with failure of acetaminophen therapy in infants < 32 weeks gestation.

Design/Methods: Retrospective cohort study of all infants born < 32 weeks gestation at a level 3 NICU (ADC: 45, >700 annual admissions) between 04/2018-05/2024. Infants who received acetaminophen for PDA were identified; data on baseline demographics, clinical variables and comorbidities were collected. Patients were divided into two groups based on response to acetaminophen: responders (RA) and non-responders (NRA). Variables were compared between the two groups using Pearson’s Chi-squared test, Fisher’s exact test and Wilcoxon rank sum test. The Benjamini- Yekutieli correction for multiple testing was performed and adjusted p-value was calculated for each variable with p< 0.05 considered as significant.

Results: A total of 629 infants were born in this time period and 81(13%) of those received acetaminophen. There was a 23/81(28%) response rate to acetaminophen. 13/58(22%) of NRA required transcatheter closure and the rest closed spontaneously. Duration of mechanical ventilation was longer in NRA (p=0.015). On adjusting p-value, this was no longer significant. Other baseline and clinical variables were similar in both groups (Tables 1 & 2). PDA size, hemodynamic significance of PDA, timing of treatment, platelet count and incidence of thrombocytopenia were similar between the two groups. NRA had higher furosemide usage (61% vs 17%, p< 0.001) (Table 3). When infants were stratified as younger GA (23w-26w) and older GA (27w-32w), we noted a response rate of 14/59(23%) and 9/22(41%) respectively. In older GA, NRA were associated with lower median platelet count (171k vs 222k, p=0.017) and higher incidence of thrombocytopenia (platelet count < 150000) (46% vs 0%, p=0.046). In the younger GA group, we noted that more females responded to acetaminophen (79% vs 42%, p=0.018).

Conclusion(s): Older GA infants with higher platelet counts seem to respond better to acetaminophen. Of the younger GA infants, females seem to have a better chance of responding to acetaminophen for PDA closure.

Table 1: Baseline and Other Clinical Variables in Responders and Non-Responders to Acetaminophen for PDA closure


Table 2: Comorbidities in Responders and Non-Responders to Acetaminophen for PDA closure


Table 3: Outcome Variables in Responders and Non-Responders to Acetaminophen for PDA closure