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Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants
V Gournay1, C Savagner, G Thiriez
1Department of Perinatology, University Hospital, Nantes, France.
Insights
Severe hypoxemia and decreased pulmonary blood flow were observed in premature infants receiving prophylactic ibuprofen for patent ductus arteriosus. Inhaled nitric oxide therapy rapidly resolved hypoxemia, suggesting careful monitoring of pulmonary pressure is warranted.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is common in premature infants.
- Ibuprofen is used prophylactically to treat PDA in neonates.
- Randomized controlled trials (RCTs) evaluate prophylactic ibuprofen efficacy and safety.
Observation:
- Three cases of severe hypoxemia occurred post-ibuprofen administration in an RCT.
- Echocardiography revealed significantly reduced pulmonary blood flow in affected infants.
- Hypoxemia symptoms resolved swiftly with inhaled nitric oxide (iNO) treatment.
Findings:
- Prophylactic ibuprofen may be associated with severe hypoxemia in extremely premature infants (<28 weeks gestation).
- Reduced pulmonary blood flow is a potential mechanism for ibuprofen-induced hypoxemia.
- Inhaled nitric oxide is an effective treatment for this specific type of hypoxemia.
Implications:
- Investigators in PDA trials should closely monitor pulmonary pressure and oxygenation.
- Further research is needed to understand the mechanism of ibuprofen-induced hypoxemia.
- Clinical vigilance is crucial when administering prophylactic ibuprofen to vulnerable premature infants.
Abstract:
We report three cases of severe hypoxaemia after ibuprofen administration during a randomised controlled trial of prophylactic treatment of patent ductus arteriosus with ibuprofen in premature infants born at less than 28 weeks of gestation. Echocardiography showed severely decreased pulmonary blood flow. Hypoxaemia resolved quickly on inhaled nitric oxide therapy. We suggest that investigators involved in similar trials pay close attention to pulmonary pressure if hypoxaemia occurs after prophylactic administration of ibuprofen.