Closure of Patent Ductus Arteriosus With Oral Ibuprofen Suspension in Premature Newborns: A Pilot Study

Heyman, Eli; Morag, Iris; Batash, D; Keidar, Ran; Baram, Shaul; Berkovitch, Matitiahu

doi:10.1542/peds.112.5.e354

Cited by 69 publications

(54 citation statements)

References 41 publications

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“…To complicate matters further, there is no consensus among experts as to which echocardiographic findings define a hemodynamically significant PDA [16][17][18][19][20][21] . Measurement of B-type natriuretic peptide has recently been described as a potential tool for ductal assessment, but has not become universally accessible [22,23] .…”

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confidence: 99%

Near-Infrared Spectroscopy as a Screening Tool for Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

Underwood

Milstein

Sherman³

2006

Neonatology

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Background: Patent ductus arteriosus (PDA) is frequent and potentially pathologic in preterm infants. A simple bedside tool to screen for ductal patency would assist in the care of extremely low birth weight (ELBW) infants. Objective: To investigate the utility of near-infrared spectroscopy (NIRS) in identifying ELBW infants who would benefit from early echocardiography. Methods: Tissue oxygen saturation (S_tO₂) was measured by NIRS in the lungs, brain, skeletal muscle and kidney of 20 ELBW infants. Comparisons were made between the S_tO₂ in these organs and the need for intervention for a PDA. All studies were performed within the first 4 days of life. Similar measurements were performed following treatment with indomethacin in nine of the patients. Results: The S_tO₂of skeletal muscle (left deltoid) and kidney differed between the infants who were treated for PDA and those who were not (p = 0.01 for both). As a screen for a PDA requiring intervention, deltoid S_tO₂ had sensitivity 77% and specificity 83%, and kidney S_tO₂ had sensitivity 85% and specificity 83%. Following treatment with indomethacin, the low S_tO₂ in the deltoid and kidney increased toward the range seen in patients who did not require treatment of a PDA. Inter- and intra-observer variability ranged from minimal to high. Conclusion: This pilot study of a portable NIRS device shows encouraging efficacy in identifying ELBW infants who were likely to benefit from early echocardiography and subsequent intervention to close a PDA. Further study is warranted.

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confidence: 99%

Near-Infrared Spectroscopy as a Screening Tool for Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

Underwood

Milstein

Sherman³

2006

Neonatology

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“…Öte yandan a¤z›dan ibuprofen kolayca temin edilebilir olmas›, gereken dozun çok az volümde verilebilmesi, kolay uygulanabilir olmas› ve ucuz olmas› gibi üstünlüklere sahiptir. Damardan verilen ibuprofenle ayn› doz flemas›n›n kullan›ld›¤› bir çal›flmada SSS'si olan PDA'l› erken do¤mufl bebeklerde %95,5 etkinlikle duktusun kapand›¤› bildirilmifltir (20). Tüm bu literatür bilgilerini kendi çal›flmam›zla k›yaslad›¤›m›zda PDA tan›l› hastalar›m›z›n %32'sinde tek, %5'inde de ikinci kez a¤›zdan ibuprofen tedavisi ile baflar›l› duktal kapanma sa¤land›.…”

Section: Tart›flmaunclassified

Erken doğmuş bebeklerde klinik olarak anlamlı patent duktus arteriyozus tedavisinde oral ibuprofenin etkinliği

Arslan¹,

Olukman²,

Çalkavur³

et al. 2010

tpa

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E Er rk ke en n d do o¤ ¤m mu ufl fl b be eb be ek kl le er rd de e k kl li in ni ik k o ol la ar ra ak k a an nl la am ml l› › p pa at te en nt t d du uk kt tu us s a ar rt te er ri iy yo oz zu us s t te ed da av vi is si in nd de e o or ra al l i ib bu up pr ro of fe en ni in n e et tk ki in nl li i¤ ¤i i T Th he e e ef ff fi ic ca ac cy y o of f o or ra al l i ib bu up pr ro of fe en n i in n t th he e t tr re ea at tm me en nt t o of f c cl li in ni ic ca al ll ly y s si ig gn ni if fi ic ca an nt t p pa at te en nt t d du uc ct tu us s a ar rt te er ri io os su us s i in n p pr re et te er rm m i in nf fa an nt ts s M Mü üj jg ga an n A Ar rs sl la an n, , Ö Öz zg gü ür r O Ol lu uk km ma an n, , fi fie eb bn ne em m Ç Ça al lk ka av vu ur r, , F Fü üs su un n A At tl l› ›h ha an n, , T Ti im mu ur r M Me efl fle e, , ‹ ‹s sm ma ai il l C Ce en ng gi iz z Ö Öz zt tü ür rk k, , S Su um mm ma ar ry yAim: This study was designed to investigate the incidence of patent ductus arteriosus (PDA) by echocardiographic examination, to determine spontaneous closure rates, to investigate the efficacy of oral ibuprofen in the treatment of hemodynamically significant PDA and to define potential drug side effects in preterm infants followed at the neonatology department of ‹zmir Dr. Behçet Uz Children's Hospital. Material and Method:Between September 2007-January 2009, 623 preterm infants were evaluated by echocardiography within first 24-48 postnatal hours. Oral ibuprofen treatment was administered to patients with clinically and hemodynamically significant PDA at 10 mg/kg/day initial dose, and following second and third doses of 5 mg/kg/day with 24 hours intervals. A second course of ibuprofen was given to patients whose was not closed PDA after the first course. Patients who didn't respond to the second course underwent surgical ligation.Results: One hundred out of 623 patients were diagnosed as PDA (%16). Spontaneous closure rate was 61%. In ninetyfive percent of remaining 39 patients PDA was closed after oral ibuprofen administration. Five percent had to undergo surgical ligation. We didn't observe any considerable side effects. As the gestational week and the birthweight increased, spontaneous closure rate increased. On the other hand as the ductal size and the ratio of left atrium to aortic root increased spontaneous closure rate decreased. Conclusions:Data suggest that oral ibuprofen may be a safe, effective and low cost treatment choice in closing PDA because of its reasonable side effects and practical applicability. (Turk Arch Ped 2010; 45: 329-33)

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“…In nonrandomized open trials, Heyman et al, [24] and Cherif et al, [17] reported a ductal closure with oral ibuprofen respectively in 21 (95.4%) of 22 patients, 38 (95%) of 40 patients, and in 11 (84.6%) of 13 patients. The authors concluded that oral ibuprofen might constitute a feasible alternative in the treatment of PDA.…”

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confidence: 99%

Oral Versus Intravenous Ibuprofen for the Early Closure of Patent Ductus Arteriosus in Low Birth Weight Preterm Infants

Hoxha¹,

Kola²,

Kuneshka³

et al. 2013

EMHPJ

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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 ■

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Closure of Patent Ductus Arteriosus With Oral Ibuprofen Suspension in Premature Newborns: A Pilot Study

Cited by 69 publications

References 41 publications

Near-Infrared Spectroscopy as a Screening Tool for Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

Near-Infrared Spectroscopy as a Screening Tool for Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

Erken doğmuş bebeklerde klinik olarak anlamlı patent duktus arteriyozus tedavisinde oral ibuprofenin etkinliği

Oral Versus Intravenous Ibuprofen for the Early Closure of Patent Ductus Arteriosus in Low Birth Weight Preterm Infants

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