Uso do paracetamol para tratamento de persistência do canal arterial em recém-nascidos prematuros: Uma revisão sistemática
DOI:
https://doi.org/10.33448/rsd-v11i14.36002Palavras-chave:
Persistência do canal arterial; Recém-nascido prematuro; Tratamento farmacológico; Paracetamol.Resumo
Objetivo: A persistência do canal arterial associa-se a múltiplas complicações e alta mortalidade neonatal. Este estudo objetiva avaliar a eficácia e os benefícios do uso do paracetamol frente ao ibuprofeno e à indometacina, antiinflamatórios não esteroidais usualmente utilizados no fechamento do canal arterial em prematuros. Fonte de dados: Foram realizadas buscas nas bases de dados PubMed, SciELO, Lilacs, Bireme, ClinicalTrials.gov e Embase considerando o período entre janeiro 2005 e dezembro 2020 e utilizando os descritores Recém-Nascido Prematuro, Persistência do Canal Arterial, Farmacoterapia, Fechamento, Paracetamol/Acetaminofeno. A qualidade dos trabalhos foi avaliada pela classificação do Oxford Centre for Evidence based Medicine. Síntese de dados: O paracetamol apresenta eficácia semelhante ao ibuprofeno e a indometacina, com menores taxas de hemorragias gastrointestinais e intracerebrais, perfuração intestinal espontânea, plaquetopenia, intolerâncias hepática e renal, e menores valores séricos de ureia, creatinina e bilirrubina. O paracetamol demonstra ser mais vantajoso do que o placebo ou a não intervenção e pode ser a melhor opção terapêutica em casos de contraindicação a outros fármacos. Idade gestacional e peso ao nascer foram descritos como influenciadores na eficácia do paracetamol, que teve menor ação em prematuros extremos, de extremo baixo peso e de muito baixo peso ao nascer. Conclusões: Outros estudos clínicos e prospectivos são necessários para corroborar a indicação do paracetamol na persistência do canal arterial. Contudo, esse fármaco demonstra ser uma alternativa farmacológica promissora, tendo eficácia semelhante aos antiinflamatórios não esteroidais clássicos, com menos efeitos adversos.
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