Aspirin
Aspirin is a nonsteroidal anti-inflammatory
drug that has a variety of uses in pediatrics. It is used in conditions such as
Kawasaki disease, polyarthritis
of rheumatic fever,
rheumatic heart disease, and
systemic rheumatoid arthritis.
Although aspirin is an effective antipyretic agent, because of its association
with Reye syndrome in children and adolescents, it is not
recommended for the treatment of fever.
Several complications are
associated with aspirin use. In a patient who is receiving long- term aspirin
therapy, the most likely complication is a
gastric ulcer. Aspirin is
believed to cause gastric ulcers by
inhibiting prostaglandin synthesis, thus altering the normal mucosal protective
mechanisms. Of those patients taking non-steroidal anti-inflammatory
drugs chronically, approximately 25%
experience gastric ulcers, and many more experience erosions.
Aspirin can cause reactions that appear
to be allergic, such as urticaria, angioedema, or asthma. However, such
reactions to aspirin probably are not
immunoglobulin E-mediated; rather, they are
related to inhibition of prostaglandin
synthesis because structurally unrelated
nonsteroidal anti-inflammatory drugs can
produce similar reactions. Anaphylaxis usually is not seen with aspirin
use.
The prevalence of Reye syndrome (acute
encephalopathy and fatty degeneration of the liver) has decreased
markedly since the relationship between the syndrome and aspirin use in patients
who had varicella or influenza was recognized in the 1970s.
Aspirin and other non-steroidal anti-inflammatory drugs can cause tinnitus and, rarely, hearing loss that is reversible with discontinuation of the drug. Although some hematologic problems are associated with aspirin use, including anemia, thrombocytopenia, reduced platelet function, prolonged prothrombin times, coagulopathy, and disseminated intravascular coagulation, generalized bone marrow suppression is not a common complication.
References:
Karpen SJ. Update on the etiologies and management of neonatal
cholestasis. Clin Perinatol. 2002;29:159-180.
Abstract available online
Mews C, Sinatra FR. Cholestasis in infancy. Pediatr Rev. 1994;15:233-240.
Abstract available online