Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants

Abstract

PurposePlasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA).MethodsBefore March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved.ResultsThe BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment.ConclusionIndividualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA.

Diagnosis and Management of Patent Ductus Arteriosus

“…Shin et al stopped treatment with ibuprofen in infants with a PDA when BNP concentration dropped to less than 600 pg/mL, resulting in fewer doses of ibuprofen in the group whose treatment was tailored based on BNP. (18)…”

Application of B-Type Natriuretic Peptide in Neonatal Diseases

“…However, no cutoff value of baseline BNP level was established to predict the efficacy of ibuprofen in premature neonates with hsPDA. Shin et al ( 80 ) found that ibuprofen can be stopped when the estimated BNP level is lower than 600 pg/mL to avoid unnecessary cyclooxygenase inhibitor doses and that this does not increase catheter closure failure and short-term morbidity related to sPDA. Moreover, King et al ( 81 ) used the BNP level to assess the use of acetaminophen in infants with hsPDA older than 2 weeks, and the BNP level of some infants with hsPDA decreased after treatment.…”

Size of Patent Ductus Arteriosus and Echocardiographic Markers of Shunt Volume in Preterm Infants Based on Postnatal Age

“…(3) difficulty in maintaining the blood pressure, i.e., hypotension (the lower limit of normal mean arterial pressure was regarded to corrected gestational age) without response to loading fluid and infusion of dopamine; (4) a worsening ventilator status; and (5) chest radiographic evidence, i.e., pulmonary congestion or cardiomegaly (a cardiothoracic ratio >60%) with increased pulmonary flow. Symptomatic PDA was defined as the presence of two of these five signs with the confirmation of a large left to right ductal flow by color flow Doppler echocardiography (11).…”