Pharmacotherapy for patent ductus arteriosus closure

Ferguson, John

doi:10.1111/chd.12715

Cited by 19 publications

(20 citation statements)

References 38 publications

(60 reference statements)

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“…Next to the ongoing discussion on the type of drug being either ibuprofen, indomethacin, or acetaminophen (117)(118)(119)(120)(121)(122)(123)(124), the timing of treatment initiation varies widely between studies, and might explain reported differences in efficacy. As spontaneous ductus closure increases with PNA, part of ductus closure reported in prophylactic and early treatment studies may be due to spontaneous closure rather than drug treatment.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review

et al. 2020

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The optimal management strategy for patent ductus arteriosus in preterm infants remains a topic of debate. Available evidence for a treatment strategy might be biased by the delayed spontaneous closure of the ductus arteriosus in preterm infants, which appears to depend on patient characteristics. We performed a systematic review of all literature on PDA studies to collect patient characteristics and reported numbers of patients with a ductus arteriosus and spontaneous closure. Spontaneous closure rates showed a high variability but were lowest in studies that only included preterm infants with gestational ages below 28 weeks or birth weights below 1,000 g (34% on day 4; 41% on day 7) compared to studies that also included infants with higher gestational ages or higher birth weights (up to 55% on day 3 and 78% on day 7). The probability of spontaneous closure of the ductus arteriosus keeps increasing until at least 1 week after birth which favors delayed treatment of only those infants that do not show spontaneous closure. Better prediction of the spontaneous closure of the ductus arteriosus in the individual newborn is a key factor to find the optimal management strategy for PDA in preterm infants.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review

et al. 2020

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“…Similarly, Sallmon H [33] observed that the complete closure rate following paracetamol administration is only 21.1% (4/19) in VLBW infants, in line with the closure rate of 27.5% (24/87) observed after paracetamol treatment in this study. Further, 3 other trials revealed that paracetamol was not as effective as ibuprofen, [34,35] and in a fourth trial PDA closure was only 18% with high-dose intravenous paracetamol in VLBW infants. [36]…”

Section: Discussionmentioning

confidence: 99%

Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

Lu¹,

Li²,

Lin³

et al. 2019

Medicine

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Paracetamol (acetaminophen) has been proposed as an alternative medication for closing hemodynamically significant patent ductus arteriosus (PDA). However, the clinical outcomes remain inconclusive in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. The aim of this study was to compare the efficacy and safety of oral paracetamol and ibuprofen for pharmacological closure of PDA in premature infants from a real-world study. This retrospective study enrolled 255 preterm infants with birthweights of ≤1.5 kg, and echocardiographically confirmed significant PDA. Subjects were classified into 3 groups: Group I (standard-dose ibuprofen group) received 10 mg/kg oral ibuprofen followed by 5 mg/kg/day for 2 days. Group II (high-dose ibuprofen group) received 10 mg/kg/day oral ibuprofen for 3 days. Group III (paracetamol group) received 15 mg/kg/6 h oral paracetamol for 3 days. On day 9 after medication start, PDA closure was achieved in 61 (71.7%) patients assigned to the high-dose ibuprofen group, (63.8%) in the standard-dose ibuprofen group, and 33 (37.9%) of those in the oral paracetamol group ( P <.001). Oral standard-dose ibuprofen was more effective than oral paracetamol ( P = .001). The ductus closed faster in the high-dose ibuprofen group than in the standard-dose group (median closure time 3.9 ± 1.0 versus 4.4 ± 1.0 days, P = .009). Total bilirubin significantly increased in the high-dose ibuprofen group ( P = .02). No gastrointestinal, renal, or hematological adverse effects were reported. Subgroup analyses indicated paracetamol was minimally effective in ELBW infants (PDA closure 13%). This study demonstrated that paracetamol may be a poor medical alternative for PDA management in VLBW and ELBW infants. High dosage ibuprofen was associated with a faster clinical improvement and higher rate of PDA closure.

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“…As no other treatment option was available for PDA in Japan before 2018, intravenous IND administration remains the only conventional pharmacologic treatment to promote PDA closure in premature infants. However, concern remains regarding its safety, including its effects on renal, gastrointestinal, and cerebral perfusion, which may lead to complications such as transient or permanent renal dysfunction, NEC, gastrointestinal hemorrhage / perforation, and reduced cerebral intracellular oxygenation . In addition, hyperbilirubinemia, hypoglycemia, and thrombocytopenia are also the most common clinically encountered side effects of IND, especially in premature infants.…”

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confidence: 99%

The influence on renal function of ibuprofen treatment for patent ductus arteriosus in extremely low birthweight infants

Nishizaki

Matsuda

Yoneyama

et al. 2020

Pediatrics International

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Background Ibuprofen (IBU) has been used recently for the treatment of patent ductus arteriosus (PDA) in Japan. We aimed to investigate the efficacy and adverse events of IBU and compare them with those of indomethacin (IND) as PDA treatment for extremely low‐birthweight infants (ELBWIs), focusing on short‐term renal function. Methods A case‐control study was conducted on 16 ELBWIs. The data from eligible patients were divided into two groups. Ten patients had undergone IND treatment (IND group) between January 2017 and June 2018, whereas six had undergone IBU treatment (IBU group) for PDA between July 2018 and December 2018. The IND group received 0.1 mg/kg/12h IND IV infusion for three doses, whereas the IBU group received 10 mg/kg IV IBU infusion followed by 5 mg/kg/day for 2 days. We compared the efficacy for PDA closure and renal impairment between the two groups. Results No significant differences in primary closure rates and the PDA ligation required were observed between the two groups. No significant differences were observed between the incidence of intraventricular hemorrhage and gastrointestinal complications in both groups. Changes in urine volume (%) in the IBU group were significantly higher than in the IND group at 24–36 h post‐administration. The urinary L‐type fatty acid binding protein concentration level at 7 days of life was significantly lower in the IBU group than in the IND group. Conclusion Although IBU was comparable to IND in PDA closure rate, IBU was superior to short‐term renal injury in ELBWIs.

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Pharmacotherapy for patent ductus arteriosus closure

Cited by 19 publications

References 38 publications

Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review

Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review

Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

The influence on renal function of ibuprofen treatment for patent ductus arteriosus in extremely low birthweight infants

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