Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus

Pezzati, Marco; Vangi, Venturella; Biagiotti, R; Bertini, Giovanna; Cianciulli, D; Rubaltelli, Firmino F.

doi:10.1016/s0022-3476(99)70093-4

Cited by 246 publications

(158 citation statements)

References 26 publications

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“…Search results and citation lists for prior publications identified 75 randomized-controlled trials of interventions that close a PDA in preterm infants. In 26 trials (five comparing long and short courses of indomethacin, [37][38][39][40][41] 19 comparing indomethacin and ibuprofen, [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and two that included very early crossover to treatment of nonresponders 29,61 ), rates of ductal closure did not differ between treatment assignments, precluding evaluation of effects of ductal closure on other outcomes, so these were excluded. The remaining 49 trials, 36, including 4728 subjects, were deemed potentially informative, as all but one documented substantial reduction in ductal patency after treatment.…”

Section: Findings From Individual Randomized-controlled Trialsmentioning

confidence: 99%

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

2010

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Section: Findings From Individual Randomized-controlled Trialsmentioning

confidence: 99%

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

2010

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“…In the accessible literature, the authors mainly assess the results of PDA treatment in relationship to the chosen method of treatment (1,11). In many studies, the treatment results (efficacy, complications, period of mechanical ventilation, lung compliance) are analyzed in the aspect of neonatal age at the time of treatment (7,12).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Macroscopic Lung Appearance in Premature Infants with Body Weights Less than 1000 G Undergoing Surgical Treatment for PDA

Wieteska¹,

Karolczak²

2007

Polish Journal of Surgery

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The aim of the study was to assess the relationship between intraoperatively observed macroscopic pathologic findings in the left lung and the chosen clinical factors. The factors analyzed in the study were the following: neonatal gestational age and body weight, the age of the neonate at the time of surgery, the history of intrauterine infection and/or presence of active infection in the neonate, the history of ibuprofen treatment, and intraoperative diameter of the arterial duct. Material and methods. The authors included a group of 126 preterm infants with body weight less than 1000 g undergoing surgical treatment for PDA in the 2 nd Department of Cardiac and General Pediatric Surgery between January 2000 and May 2006 and analyzed the macroscopic intraoperative left lung appearance. The average body weight of the neonates who participated in the study was 765.2 g, with the average gestational age 25.68 Hbd. According to the results of intraoperative macroscopic lung assessment, the neonates were classified into one of the following three groups: 0 -normal lungs or partially stiff lungs with emphysema focuses, 1 -limited macroscopic findings, focuses of limited atelectasis, lung congestion, 2 -severe pathologic findings in the pulmonary tissue, pulmonary hematomas, bleeding pulmonary surface, disseminated atelectasis, liver-like pulmonary tissue. In the study, the statistical analysis of the relationship between pathological pulmonary findings (groups 0, 1, 2) and investigated factors was performed by the comparison of mean values (or median) of the investigated factor in the analyzed groups. The Kruskal-Wallis and the Mann-Whitney tests were used dependent of the analyzed factor. Additionally, for chosen factors (the infection presence and PDA diameter), their relationship with the lung macroscopic appearance was assessed with the use of the Spearman test. Results. The pathological findings in the lungs were observed in the majority of the neonates (54%). The statistical analysis did not show any relationship between the pulmonary disorders and the majority of investigated factors. Conclusions. 1. The authors found that a duct diameter of ³ 4 mm correlates with the development of more severe disorders in the pulmonary tissue. 2. The authors emphasized the good results of surgical treatment of PDA and the lack of death in the perioperative period in that group of patients. Key words: PDA, ELBW, thoracotomy, lungs Patent ductus arteriosus (PDA) is observed in the majority of premature infants with extremely low body weight. The prevalence of PDA is higher with lower gestational age and lower body weight (1, 2). The relationship was demonstrated between the presence of PDA and not only the newborn gestational age but also the coexistence of respiratory distress and the general health condition of the newborn (3, 4). Significant left-to-right shunt through the arterial duct causes lung congestion, which can result in alveolar transudation. It can cause impaired alveolar ventilation, the development of atelectasis...

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“…18,19 Indomethacin more profoundly decreases renal blood flow compared to ibuprofen lysine, resulting in significant oliguria and an increase in serum creatinine levels. 20,21 Meta-analysis of studies comparing these drugs reveals no significant differences in the incidence of NEC, BPD at 36 weeks or neurodevelopmental outcome at 18 months of age. [22][23][24] Because these drugs are highly protein bound they can potentially compete with bilirubin for albumin binding sites and increase the risk of bilirubin encephalopathy.…”

Section: Treatment Options For Pdamentioning

confidence: 99%

Treatment of patent ductus arteriosus: indomethacin or ibuprofen?

Sekar

Corff

2008

J Perinatol

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Persistent patent ductus arteriosus (PDA) in preterm infants can result in serious hemodynamic changes causing respiratory, gastrointestinal and renal morbidities if not treated within the first week of life. The treatment options available are a conservative approach, pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The COX inhibitors approved for use in the United States are indomethacin and ibuprofen lysine. Both of these drugs are equally effective in closing the PDA. Subtle differences exist between these two preparations. Indomethacin has a protective effect on the incidence of intraventricular hemorrhage (IVH) but reduces the blood flow to the kidneys and the brain. Ibuprofen is less toxic but has no effect on IVH. Efficacy of pharmacological treatment is influenced by timing of initiation of therapy. Surgical treatment is the only option when pharmacological treatment fails to close the PDA in symptomatic infants. Long-term neurological and respiratory morbidities are associated with surgical ligation. This paper reviews these medical considerations in the treatment options for PDA in premature infants.

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Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus

Cited by 246 publications

References 26 publications

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

Intraoperative Macroscopic Lung Appearance in Premature Infants with Body Weights Less than 1000 G Undergoing Surgical Treatment for PDA

Treatment of patent ductus arteriosus: indomethacin or ibuprofen?

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