Prophylactic ibuprofen in premature infants: a multicentre, randomised, double-blind, placebo-controlled trial

Overmeire, Bart Van; Allegaert, Karel; Casaer, Alexandra; Debauche, Christian; Decaluwe, W; Jespers, Ann; Weyler, Joost; Harrewijn, Inge; Langhendries, Jean‐Paul

doi:10.1016/s0140-6736(04)17477-1

Cited by 132 publications

(96 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the placebo arm of the prophylactic COX inhibitor studies, about 50% of the very preterm infants closed their ductus spontaneously or never developed evidence of a hemodynamically significant PDA. 33,39,44 Watchful waiting approach Given the high rate of spontaneous closure at least in the more mature very low birth weight infants and the concern over side effects of the COX inhibitors, it may appear reasonable to wait and see whether the ductus arteriosus closes on its own before considering treatment. In evaluating this approach, one needs to examine whether there is any drawback to not treating PDA until it declares itself.…”

Section: Introductionmentioning

confidence: 99%

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

Noori

2010

J Perinatol

View full text Add to dashboard Cite

Pharmacological and/or surgical closure of a hemodynamically significant patent ductus arteriosus (PDA) in the very preterm infant has been the standard of care over the past few decades. However, the rationale for closure of PDA has recently been challenged. In this article, the factors that have fueled the controversy of the approach to the management of PDA and the gap in our knowledge are reviewed in detail. In addition, the pros and cons of the different treatment strategies applied in clinical care are evaluated with a focus on discussing the available evidence in the literature.

show abstract

Section: Introductionmentioning

confidence: 99%

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

Noori

2010

J Perinatol

View full text Add to dashboard Cite

show abstract

“…The incidence of DA patency has been estimated to be 1 in 500 in term newborns [17]. In preterm babies with birth weights <1,500 g, the incidence of patent DA exceeds 30 % [18]. Therefore, it is important to improve current pharmacological therapy through understanding the precise mechanisms of the regulation of the DA.…”

Section: Future Direction and Clinical Implicationsmentioning

confidence: 99%

The Multiple Roles of Prostaglandin E2 in the Regulation of the Ductus Arteriosus

Yokoyama

Minamisawa

Ishikawa

2016

Etiology and Morphogenesis of Congenital Heart Disease

View full text Add to dashboard Cite

The ductus arteriosus (DA) is a shunt vessel between the aorta and the pulmonary artery during the fetal period. It is well recognized that prostaglandin E 2 (PGE 2 ) dilates the DA through activation of its receptor EP4 and subsequent cyclic AMP (cAMP) production during the fetal period and that oxygen constricts the DA by inhibiting potassium channels immediately after birth. In addition to the regulation of vascular tone, morphological remodeling of the DA throughout the perinatal period, such as prominent intimal thickening and poor elastogenesis, has been demonstrated.We recently identified the molecular mechanisms of the acquisition of unique morphological remodeling in the DA during development. During the fetal period, PGE 2 -EP4 signaling decreases elastic fiber formation through degradation of the cross-linking enzyme lysyl oxidase (LOX) and increases hyaluronanmediated intimal thickening in the DA. This remodeling is mediated by activation of the EP4 receptor via diverse downstream intracellular signaling pathways. Hyaluronan-mediated intimal thickening was induced by the EP4-Gs protein-cyclic AMP-protein kinase A pathway. The attenuation of elastogenesis is mediated through a non-cyclic AMP signaling pathway, such as c-src-phospholipase C (PLC). These data suggest that placental PGE 2 -mediated vascular remodeling via different signaling pathways orchestrates the subsequent luminal DA reorganization, leading to complete obliteration of the DA.

show abstract

“…29 Ibuprofen lysine when given as prophylaxis compared to placebo showed significant PDA closure rates 22,23 but did not have an effect on the incidence of IVH. 30 Studies comparing indomethacin and ibuprofen lysine showed equal efficacy rates in ductal closure. 7,31 In these comparative trials, the indomethacin group had statistically significant higher incidence of oliguria and elevated creatinine levels.…”

Section: Treatment Options For Pdamentioning

confidence: 99%

Treatment of patent ductus arteriosus: indomethacin or ibuprofen?

Sekar

Corff

2008

J Perinatol

View full text Add to dashboard Cite

Persistent patent ductus arteriosus (PDA) in preterm infants can result in serious hemodynamic changes causing respiratory, gastrointestinal and renal morbidities if not treated within the first week of life. The treatment options available are a conservative approach, pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The COX inhibitors approved for use in the United States are indomethacin and ibuprofen lysine. Both of these drugs are equally effective in closing the PDA. Subtle differences exist between these two preparations. Indomethacin has a protective effect on the incidence of intraventricular hemorrhage (IVH) but reduces the blood flow to the kidneys and the brain. Ibuprofen is less toxic but has no effect on IVH. Efficacy of pharmacological treatment is influenced by timing of initiation of therapy. Surgical treatment is the only option when pharmacological treatment fails to close the PDA in symptomatic infants. Long-term neurological and respiratory morbidities are associated with surgical ligation. This paper reviews these medical considerations in the treatment options for PDA in premature infants.

show abstract

Prophylactic ibuprofen in premature infants: a multicentre, randomised, double-blind, placebo-controlled trial

Cited by 132 publications

References 28 publications

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

The Multiple Roles of Prostaglandin E2 in the Regulation of the Ductus Arteriosus

Treatment of patent ductus arteriosus: indomethacin or ibuprofen?

Contact Info

Product

Resources

About