The experience of pharmacological closing hemodynamically significant patent ductus arteriosus in premature infants at the regional level
AbstractBackground. The presence of hemodynamically significant patent ductus arteriosus (PDA) in very low birth weight preterm infants may lead to the development of severe complications and even death. Priority in care of hemodynamically significant PDA during early postnatal life is given to the conservative treatment by use cyclooxygenase inhibitors. However, conservative treatment of hemodynamically significant PDA may also be accompanied by the development of some complications, despite the high efficiency (70–80%).
Purpose. To evaluate the results of pharmacological closure of PDA by use ibuprofen in preterm infants in Yaroslavl region.
Materials and methods. In a retrospective clinical study included medical data about 17 preterm infants with gestational age less than 34 weeks. All children were born in the Regional Perinatal Center of Yaroslavl region from January, 1, 2012 to October, 1, 2012 and after birth were admitted to the neonatal intensive care unit of the same clinic. All children underwent serial abdominal circumference measurement, echocardiography, Doppler study of blood flow in the middle cerebral artery with calculation of the resistance index (IR). Ibuprofen was administered from2 to 6 day of life, taking into account contraindications.
Results. The effectiveness of ibuprofen using for closure of the hemodynamically significant PDA was 77,8%. A significant decrease in IR was noted during treatment with ibuprofen, which may be considered as an additional criterion for the effectiveness of the conservative therapy. Among the complications during conservative treatment of the hemodynamically significant PDA frequently reported necrotizing enterocolitis (NEC), and thrombocytopenia. A low platelet count before treatment was correlated with their more significant decline during therapy with ibuprofen. Abdominal circumference increased signifi cantly during conservative treatment of the hemodynamically significant PDA in children who developed NEC later. No adverse effects of ibuprofen treatment found on renal function.
Conclusions. Ibuprofen is an effective means for conservative closure of hemodynamically significant PDA. Ibuprofen use is associated with the development of NEC and thrombocytopenia. More lower level of platelet count at initiation of treatment is associated with the greater risk of developing severe thrombocytopenia. Serial measurement of abdominal circumference of the neonate can be considered as an objective method of monitoring and early detection of NEC.
Keywords:premature infants, patent ductus arteriosus, ibuprofen
Neonatology: News, Opinions, Training. 2013; (2): 48–48.