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Prophylaxis of patent ductus arteriosus with ibuprofen in preterm infants
1Division of Neonatology, Careggi University Hospital of Florence, Italy. cdani@.unifi.it
Insights
Prophylactic ibuprofen significantly reduced the incidence of patent ductus arteriosus (PDA) in preterm infants with infant respiratory distress syndrome (iRDS). Both prophylactic and rescue ibuprofen effectively closed PDA without adverse effects.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is a common complication in preterm infants with infant respiratory distress syndrome (iRDS).
- Early intervention for PDA is crucial to prevent adverse outcomes.
- Ibuprofen is a potential treatment for PDA, but optimal timing remains under investigation.
Purpose of the Study:
- To evaluate the efficacy of prophylactic versus rescue ibuprofen for PDA in preterm infants with iRDS.
- To assess the effectiveness of ibuprofen in closing PDA.
- To determine the safety profile of ibuprofen in this population.
Main Methods:
- Randomized trial of 80 preterm infants (gestational age < 34 wk) with iRDS.
- Group A received prophylactic intravenous ibuprofen within 24 hours of life.
- Group B received rescue intravenous ibuprofen after echocardiographic diagnosis of PDA.
Main Results:
- Significantly lower incidence of PDA in the prophylactic group (8%) compared to the rescue group (53%) at 3 days of life (p < 0.0001).
- Ibuprofen achieved PDA closure in 90% of infants in the rescue group.
- No significant differences in respiratory support, renal function, or rates of BPD, IVH, NEC, and ROP between groups.
- Ibuprofen was well-tolerated with no observed adverse effects.
Conclusions:
- Prophylactic ibuprofen significantly reduces PDA occurrence in preterm infants with iRDS.
- Both prophylactic and rescue ibuprofen are effective in closing PDA.
- Ibuprofen treatment for PDA in preterm infants is safe and effective.
Unlabelled:
The aim of our study was to evaluate whether the prophylactic use of ibuprofen would reduce the incidence of significant patent ductus arteriosus (PDA) and to confirm the effectiveness of ibuprofen as rescue treatment in closing PDA. Eighty preterm infants with gestational age less than 34 wk with infant respiratory distress syndrome (iRDS) were randomized to receive intravenous ibuprofen lysine (10 mg/kg, followed by 5 mg/kg after 24 and 48 h) either within 24 h of life (group A) or after echocardiographic diagnosis of PDA (group B). To evaluate the severity of RDS in each patient, we calculated the initial and highest values of Oxygenation Index (O.I. = mean airway pressure x FiO2 x 100/PaO2) and Ventilatory Index (V.I. = O.I. x mechanical respiratory rate). Other studied variables were ventilatory support, renal function, biochemical and haematological profiles, frequency of bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). On the 3rd day of life, 8% (3/40) of patients of group A and 53% of patients (21/40) of group B (p < 0.0001) developed a significant PDA. Between patients of group B who presented PDA at 3 d of life 90% (19/21) had a closure of ductus arteriosus after ibuprofen treatment. Initial and highest values of O.I. and V.I. were similar in both groups A and B. No significant differences between the groups were observed in regard to respiratory support, renal function and frequency of BPD, IVH, NEC and ROP. Ibuprofen was not associated with adverse effects.
Conclusion:
Prophylactic treatment with ibuprofen reduces PDA occurrence in preterm infants with iRDS at 3 d of life in comparison with rescue treatment, but both modes are effective in closing the ductus without significant adverse effects.