{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:22:05Z","timestamp":1756902125230,"version":"3.44.0"},"reference-count":12,"publisher":"The Pediatric Pharmacy Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022]]},"abstract":"<jats:p>A patent ductus arteriosus (PDA) results from the failure of the ductus arteriosus to close within 72 hours after birth. In most neonates, a PDA can lead to significant morbidities and often warrants pharmacologic intervention for closure. Common pharmacologic interventions include indomethacin, ibuprofen, and acetaminophen. In cases of ductal-dependent congenital heart defects (CHDs), such as hypoplastic left heart syndrome, it is imperative to keep the ductus arteriosus patent to maintain adequate pulmonary or systemic circulation until surgical intervention can be performed. The only proven pharmacologic agent used for this indication is prostaglandin E1 (PGE1) commonly in the form of intravenous alprostadil. This case report describes a neonate with multiple cardiac and genetic anomalies that required increased alprostadil infusion after exposure to rectal and oral acetaminophen. The patient initially presented with a large PDA on echocardiogram (ECHO); however, after an incidental finding of a small PDA on ECHO, the administration of as needed rectal acetaminophen was discontinued out of concern for its effects on patency. After a few days of increased prostaglandin therapy and 2 reassuring ECHO results, the patient was given oral acetaminophen on an as needed basis. Within 24 hours of restarting the acetaminophen, the repeated ECHO showed a reduction in PDA and flow. In patients with ductal-dependent cardiac lesions, it is important to maintain PDA patency and, therefore, introducing a medication with antiprostaglandin properties should be avoided.<\/jats:p>","DOI":"10.5863\/1551-6776-27.6.573","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T17:20:15Z","timestamp":1660929615000},"page":"573-577","source":"Crossref","is-referenced-by-count":0,"title":["Increasing Alprostadil Requirements in a Neonate With Cardiac Anomalies and Co-administration of Rectal and Oral Acetaminophen"],"prefix":"10.5863","volume":"27","author":[{"given":"Jennifer M.","family":"Ryder","sequence":"first","affiliation":[{"name":"Department of Pharmacy (JR, EB), Children's Hospital Colorado, Aurora, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (JR, EB), Children's Hospital Colorado, Aurora, CO"},{"name":"Heart Institute (EB), Children's Hospital Colorado, Aurora, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"3","key":"i2331-348X-27-6-573-b1","series-title":"Adv Neonatal Care","first-page":"179","article-title":"Understanding the pathophysiology, implications, and treatment options of patent ductus arteriosus in the neonatal population","volume":"19","year":"2019","unstructured":"Conrad\n              C,\n            \n            \n              Newberry\n              D.\n            \n          \n          Understanding the pathophysiology, implications, and treatment options of patent ductus arteriosus in the neonatal population.\n\t\t\t\t\tAdv Neonatal Care.\n\t\t\t\t\t2019;19(3):179\u2013187."},{"issue":"3","key":"i2331-348X-27-6-573-b2","series-title":"J Pediatr Pharmacol Ther","first-page":"138","article-title":"Patent ductus arteriosus: an overview","volume":"12","year":"2007","unstructured":"Dice\n              JE,\n            \n            \n              Bhatia\n              J.\n            \n          \n          Patent ductus arteriosus: an overview.\n\t\t\t\t\tJ Pediatr Pharmacol Ther.\n\t\t\t\t\t2007;12(3):138\u2013146."},{"issue":"12","key":"i2331-348X-27-6-573-b3","series-title":"JAMA","first-page":"1221","article-title":"Association of placebo, indomethacin, ibuprofen, and acetaminophen with closure of hemodynamically significant patent ductus arteriosus in preterm infants: a systematic review and meta-analysis","volume":"319","year":"2018","unstructured":"Mitra\n              S,\n            \n            \n              Florez\n              ID,\n            \n            \n              Tamayo,\n              ME,\n            \n          \n          .\n\t\t\t\t\tAssociation of placebo, indomethacin, ibuprofen, and acetaminophen with closure of hemodynamically significant patent ductus arteriosus in preterm infants: a systematic review and meta-analysis.\n\t\t\t\t\tJAMA.\n\t\t\t\t\t2018;319(12):1221\u20131238."},{"issue":"1","key":"i2331-348X-27-6-573-b4","series-title":"Congenit Heart Dis","first-page":"52","article-title":"Pharmacotherapy for patent ductus arteriosus closure","volume":"14","year":"2019","unstructured":"Ferguson J\n              M.\n            \n          \n          Pharmacotherapy for patent ductus arteriosus closure.\n\t\t\t\t\tCongenit Heart Dis.\n\t\t\t\t\t2019;14(1):52\u201356."},{"issue":"4","key":"i2331-348X-27-6-573-b5","series-title":"Cochrane Database Syst Rev","first-page":"CD010061","article-title":"Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants","volume":"4","year":"2018","unstructured":"Ohlsson\n              A,\n            \n            \n              Shah\n              PS.\n            \n          \n          Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants.\n\t\t\t\t\tCochrane Database Syst Rev.\n\t\t\t\t\t2018;\n\t\t\t\t\t6;4(4):CD010061."},{"issue":"2","key":"i2331-348X-27-6-573-b6","series-title":"Ann Pediatr Cardiol","first-page":"97","article-title":"Acetaminophen in low doses for closure of the ductus arteriosus of the premature","volume":"12","year":"2019","unstructured":"Guimar\u00e3es\n              AFM,\n            \n            \n              Ara\u00fajo\n              FDR,\n            \n            \n              Meira\n              ZMA,\n            \n          \n          .\n\t\t\t\t\tAcetaminophen in low doses for closure of the ductus arteriosus of the premature.\n\t\t\t\t\tAnn Pediatr Cardiol.\n\t\t\t\t\t2019;12(2):97\u2013102."},{"issue":"2","key":"i2331-348X-27-6-573-b7","series-title":"Cochrane Database Syst Rev","first-page":"CD011417","article-title":"Prostaglandin E1 for maintaining ductal patency in neonates with ductal-dependent cardiac lesions","volume":"27;2","year":"2018","unstructured":"Akkinapally\n              S,\n            \n            \n              Hundalani\n              SG,\n            \n            \n              Kulkarni\n              M,\n            \n          \n          .\n\t\t\t\t\tProstaglandin E1 for maintaining ductal patency in neonates with ductal-dependent cardiac lesions.\n\t\t\t\t\tCochrane Database Syst Rev.\n\t\t\t\t\t2018;27;2(2):CD011417."},{"issue":"4","key":"i2331-348X-27-6-573-b8","series-title":"J Crit Care Med (Targu Mures)","first-page":"185","article-title":"Congenital heart disease requiring maintenance of ductus arteriosus in critically ill newborns admitted at a tertiary neonatal intensive care unit","volume":"2","year":"2016","unstructured":"Cucerea\n              M,\n            \n            \n              Simon\n              M,\n            \n            \n              Moldovan\n              E,\n            \n          \n          .\n\t\t\t\t\tCongenital heart disease requiring maintenance of ductus arteriosus in critically ill newborns admitted at a tertiary neonatal intensive care unit.\n\t\t\t\t\tJ Crit Care Med (Targu Mures).\n\t\t\t\t\t2016;2(4):185\u2013191."},{"key":"i2331-348X-27-6-573-b9","series-title":"Curr Ther Res Clin Exp","first-page":"24","article-title":"Clinical pharmacology of paracetamol in neonates: a review","volume":"77","year":"2014","unstructured":"Pacifici\n              GM,\n            \n            \n              Allegaert\n              K.\n            \n          \n          Clinical pharmacology of paracetamol in neonates: a review.\n\t\t\t\t\tCurr Ther Res Clin Exp.\n\t\t\t\t\t2014;77:24\u201330."},{"issue":"4","key":"i2331-348X-27-6-573-b10","series-title":"Pediatr Res","first-page":"678","article-title":"Exposure to acetaminophen and all its metabolites upon 10, 15, and 20 mg\/kg intravenous acetaminophen in very-preterm infants","volume":"82","year":"2017","unstructured":"Flint\n              RB,\n            \n            \n              Roofthooft\n              DW,\n            \n            \n              van Rongen\n              A,\n            \n          \n          .\n\t\t\t\t\tExposure to acetaminophen and all its metabolites upon 10, 15, and 20 mg\/kg intravenous acetaminophen in very-preterm infants.\n\t\t\t\t\tPediatr Res.\n\t\t\t\t\t2017;82(4):678\u2013684."},{"issue":"4","key":"i2331-348X-27-6-573-b11","series-title":"Semin Perinatol","first-page":"243","article-title":"Evidence-based use of acetaminophen for hemodynamically significant ductus arteriosus in preterm infants","volume":"42","year":"2018","unstructured":"Jasani\n              B,\n            \n            \n              Weisz\n              DE,\n            \n            \n              McNamara\n              PJ.\n            \n          \n          Evidence-based use of acetaminophen for hemodynamically significant ductus arteriosus in preterm infants.\n\t\t\t\t\tSemin Perinatol.\n\t\t\t\t\t2018;42(4):243\u2013252."},{"issue":"8","key":"i2331-348X-27-6-573-b12","series-title":"Acta Anaesthesiol Scand","first-page":"855","article-title":"Plasma paracetamol concentrations and pharmacokinetics following rectal administration in neonates and young infants","volume":"43","year":"1999","unstructured":"Hansen\n              TG,\n            \n            \n              O'Brien\n              K,\n            \n            \n              Morton\n              NS,\n            \n            \n              Rasmussen\n              SN.\n            \n          \n          Plasma paracetamol concentrations and pharmacokinetics following rectal administration in neonates and young infants.\n\t\t\t\t\tActa Anaesthesiol Scand.\n\t\t\t\t\t1999;43(8):855\u2013859."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/27\/6\/article-p573.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/jppt\/article-pdf\/27\/6\/573\/3105496\/i2331-348x-27-6-573.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/27\/6\/article-p573.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/27\/6\/article-p573.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:36:51Z","timestamp":1747355811000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/27\/6\/article-p573.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022]]},"references-count":12,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-27.6.573","relation":{},"ISSN":["2331-348X","1551-6776"],"issn-type":[{"type":"electronic","value":"2331-348X"},{"type":"print","value":"1551-6776"}],"subject":[],"published":{"date-parts":[[2022]]}}}