BackgroundPatent ductus arteriosus (PDA) is common in very premature infants. Pharmacological closure of PDA with indomethacin, a prostaglandin inhibitor, has remained the mainstay of treatment in premature infants over the last three decades. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reaction in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route.This study was designed to assess the efficacy and safety of oral ibuprofen and intravenous ibuprofen for the early pharmacological treatment of PDA in LBW preterm infants with respiratory distress syndrome. MethodsA randomized, singleblinded, controlled study was performed on premature neonates at the neonatal care unit of the University Hospital for Obstetrics and GynecologyKoco Gliozheni, Tirana, Albania, from January 2010 to December 2012. The study enrolled 68 preterm infants with gestational age between 2832 weeks, birth weight ≤ 2000 g, postnatal age 4896 h, and had echocardiographically confirmed significant PDA. The preterm infants received either intravenous or oral ibuprofen randomly as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h. After the first dose of treatment in both groups, echocardiographic evaluation was performed, to determine the need for a second or third dose. The rate of ductal closure, adverse effects, complications, and the patients clinical course were recorded. ResultsAll patients were born after 28 until 32 weeks gestation. 36 patients were treated with oral ibuprofen and 32 with intravenous ibuprofen in this period. After the first course of the treatment, the PDA closed in 30 (83.3%) of the patients assigned to the oral ibuprofen group versus 23 (71.8%) of those enrolled in the intravenous ibuprofen group (p = 0.355). There was no difference between treatment groups in demographics or baseline renal function. In the evaluation of renal tolerance, none of the patients had oliguria. There were no significant differences with respect to complications during the stay. ConclusionsIn low birth weight infants, the rate of early ductal closure with oral ibuprofen is at least as good as with the intravenous route. Oral ibuprofen is associated with fewer adverse effects.■ UDC: 100 110 ■ Patent ductus arteriosus ■ Ibuprofen ■ LBW infants ■ Adverse effects ■

This article presents a case study. Sexual abuse greatly affects children's behavior, emotions and way of thinking. One of the most frequent disorders after exposure or experiencing sexual abuse is post-traumatic stress disorder. The assault does not end with the action, the way of experiencing this trauma affects the later life of the child full of long-term negative effects, if it is not intervened at the right time. Harassment or sexual abuse leads also to a weak physical health. The case of Emma, who was presented to the pediatric emergency room, with numerous physiological complaints, such as; dizziness, severe headache, unconsciousness, vomiting. Specific examinations showed the absence of any possible organic cause. Based on the sessions conducted with the patient, it appears that the girl was sexually abused. During the clinical conversation, the patient is very withdrawn, isolated and does not want to talk. Appreciating her silence, the use of art therapy was seen as appropriate. Art therapy reached very interesting findings, which were later confirmed by other medical examinations as well as subsequent conversations with the patient. Art therapy was used to assess her emotional, cognitive and rational state. Its use increased the efficiency of assessment and promoted the definition of treatment objectives. The girl was asked to draw all the members of her family. Interpretation of drawing when observed for therapeutic purposes.

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