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Is the prophylaxis of patent ductus arteriosus useful in extremely premature infants?
Iliana Bersani1, Maria Pia De Carolis, Serafina Lacerenza
1Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy.
Insights
Ibuprofen prophylaxis for patent ductus arteriosus is effective in very preterm infants. However, benefits are greater for infants with gestational age under 26 weeks, who show lower closure rates and higher surgical needs.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common complication in very preterm infants.
- Early intervention for PDA is crucial to prevent adverse outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of ibuprofen prophylaxis for PDA in very preterm neonates.
- To identify subgroups of infants who benefit most from this intervention.
Main Methods:
- A study including 200 neonates with gestational age (GA) less than or equal to 28 weeks.
- Administration of ibuprofen within the first two hours of life.
- Analysis of ductus closure rates, reopening, need for surgical ligation, and pulmonary hypertension based on GA.
Main Results:
- Overall ductus closure rate was 68%.
- Infants with GA < 26 weeks had significantly lower closure rates (48.8%) compared to those with GA >= 26 weeks (73.2%).
- Neonates with GA < 26 weeks experienced lower closure after initial therapy, higher reopening rates, and increased need for surgical ligation.
Conclusions:
- Ibuprofen prophylaxis for PDA is recommended for infants with GA < 26 weeks.
- The study highlights the importance of considering GA when deciding on PDA prophylaxis.
- Pulmonary hypertension was observed in 5.5% of neonates during prophylaxis.
Abstract:
This study was aimed to verify the efficacy and safety of ibuprofen prophylaxis of patent ductus arteriosus in very preterm infants, in order to select infants receiving higher benefits from this intervention. Two hundred neonates with gestational age (GA) < or = 28 weeks receiving ibuprofen within the first two hours of life were included. Ductus closure rate was 68%, and results were significantly dependent on GA (48.8% among neonates with GA < 26 weeks vs 73.2% among those with GA > or = 26 weeks, p < 0.01). Neonates with GA < 26 weeks showed a lower ductus closure after the primary course of therapy (20% vs 57.5%, p < 0.01), as well as higher reopening rate (16.2% vs 3.8%, p < 0.05) and need for surgical ligation (38.8% vs 5.8%, p < 0.01). During the prophylaxis period, 11 neonates (5.5%) showed pulmonary hypertension. Considering risks/benefits, we recommend prophylaxis only in infants with GA < 26 weeks.
