Patent Ductus Arteriosus In Infants Research Articles

Trends in Procedural Closure of the Patent Ductus Arteriosus among Infants Born at 22 to 30 Weeks’ Gestation

To describe recent trend in procedural closure of the patent ductus arteriosus (PDA) among premature infants and compare the clinical characteristics of infants receiving surgical vs transcatheter closure. We conducted a descriptive, retrospective cohort study of preterm infants born between 220/7 and 296/7weeks' gestation from 2014 through 2021. Infants were identified from the Pediatrix Clinical Data Warehouse. We excluded infants with any major congenital anomaly. We identified all preterm infants with a PDA and all those who underwent procedural closure (surgical ligation or transcatheter occlusion) and compared changes over time using ANOVA for continuous variables and the Cochran-Armitage trend test to evaluate time-related changes in proportions. The study cohort included 64 580 infants, of whom 24 028 (37.2%) were diagnosed with a PDA. The number of infants receiving any procedural closure of the PDA decreased from 371 (4.4%) in 2014 to 144 (1.9%) in 2021. During the same period, number of surgical ligations decreased from 369 (4.36%) to 64 (0.84%), and the number of transcatheter occlusions increased from 2 (0.02%) to 80 (1.05% p for all < 0.001). The median age at time of surgical ligation increased from 25 days (10th and 90th percentile, 10, 61) to 31days (10th and 90th percentile, 16, 66), and the median age of transcatheter occlusion decreased from 103days (10th and 90th percentile, 32, 150) to 43days (10th and 90th percentile, 22, 91). There was a decrease in surgical closure and an increase in transcatheter occlusion of the PDA in infants born at 22-30weeks' gestation from 2014 to 2021. Despite the decline in overall procedural closure, the rate of transcatheter occlusion surpassed surgical ligation by 2021. Narrowing differences in the median age and weight at closure suggest increasing overlap in the types of infants who received each type of procedural closure.

Percutaneous Closure of the Patent Ductus Arteriosus in Infants ≤2 kg: IMPACT Registry Insights.

Percutaneous patent ductus arteriosus (PDA) closure is becoming the standard of care for definitive closure in progressively smaller and younger neonates. The objective of this study was to assess safety and feasibility of percutaneous PDA closure in patients ≤2 kg. This was a cohort study using the IMPACT Registry (Improving Pediatric and Adult Congenital Treatments) from the American College of Cardiology Foundation's National Cardiovascular Data Registry. Patients who were ≤2 kg at the time of percutaneous PDA closure were included. The primary outcome was the composite of technical failure and/or major adverse event. A total of 1587 attempted PDA closures were included, with a 3% incidence of technical failure and 5.5% incidence of the composite outcome. Major adverse events were observed in 3.8% of the patients; the most common events were device embolization requiring retrieval and unplanned cardiac or vascular surgery in 1.3% and 1.3% of cases, respectively. The incidence of the composite outcome was associated with the need for arterial access (P < .001) as well as annual hospital volume of percutaneous PDA closures in infants ≤2 kg (P = .001). The incidence of the composite outcome has decreased overtime, whereas median weight at the time of procedure has also diminished. Percutaneous PDA closure appears to be safe and feasible procedures in infants ≤2 kg. The incidence of major adverse events has continued to decline over the years and seems to have a strong correlation with individual center case volumes and expertise.

Transcatheter Closure of Patent Ductus Arteriosus in infants between 2-10 kg

Objective: The aim of this study was to present our experiences on transcatheter patent ductus arteriosus (PDA) closure with different devices, mostly the Amplatzer Piccolo Occluder, in infants weighing between 2-10 kg. Material and Methods: In this study, the files of 31 patients who underwent transcatheter PDA closure between December 2019 and August 2022 were reviewed retrospectively. Results: Transcatheter PDA closure was performed on 31(14 female) infants weighing between 2-10 kg. The mean age of patients was 10.7±6.7 months (2-28), and the mean weight was 6.6±2 kg (3-9.9). The median narrowest diameter of the ductus was 2.2 mm (IQR 2-3) and the median ductus length was 6 mm (IQR 4.75-8). The procedural success rate of all interventional procedures was 88% (30 of 34). Complications occurred in a total of four patients including failure of device implantation in one patient, post-procedural device embolization in 2 patients, and the significant residual shunt in one patient. None of the patients required surgery. In 34 interventional procedures, 3 of which were reintervention, 34 devices were used. Twenty-seven (79%) of them were Amplatzer Piccolo Occluder. The median fluoroscopy and procedural times were 10.5 minutes (IQR 7.25-18.5) and 40 minutes (IQR 35-57.5) respectively. The mean duration of follow-up was 10.3±8.8 months (1-32 months). Conclusion: In our experience, transcatheter treatment of PDA with the Amplatzer Piccolo Occluder device which was our first choice for appropriate duct anatomy and size in infants weighing between 2-10 kg, is safe and effective.

Does a Change in Device Design Alter Device Size Selection? A Comparison of Conventional and Occlutech Duct Occluder Designs.

The Occlutech duct occluder (ODO) with a novel design has been available for closure of patent ductus arteriosus (PDA) since 2011. Available data on initial experience with the ODO have shown that operators continue to choose device sizes based on their experience with conventional duct occluders (CDO). This study postulated that occlusion of the pulmonary arterial (PA) end of the ductus should achieve satisfactory PDA closure without additional complications. Accordingly, the size of the ODO was chosen such that the larger PA diameter in the new design exceeded the PA end of the ductus by 2-3 mm and 2-4 mm for normotensive and hypertensive ducts, respectively. It sought to examine the feasibility and safety of such an approach, and compared ODO and CDO devices with respect to device sizes deployed, to ascertain if the newer design had any advantages. This prospective study enrolled 105 infants, children and a few adults with various duct morphologies and PA pressures for ductal closure using the ODO from 2018-2020. The control group consisted of 105 ducts closed with CDO. A comparison of the two groups with respect to duct diameter and implanted device sizes was performed using appropriate statistical software. The study found that 40% of the ducts had moderate-to-severe pulmonary hypertension. Most ducts measured between 3-4 mm in both groups. The mean weight of the subjects in both groups was 12 kg. Although there was no change in the way that duct occluders were chosen in both groups (2-3 mm over the pulmonary artery diameter), ODO could be significantly downsized in most ducts measuring between 2.5-6.4 mm in diameter (p<0.05). This study found successful closure of relatively larger PDA in infants and children using smaller ODO compared with CDO, without embolisation or aortic narrowing. It also demonstrated that a different device size selection technique may be safely employed with the ODO.

Outcomes of Surgical Management for Patent Ductus Arteriosus in Infants in Nigeria.

Patent ductus arteriosus is a common cardiac anomaly in infants that, if untreated, is associated with high morbidity and mortality rates. In lower-middle-income countries, such as Nigeria, obtaining cardiovascular surgical care for infants remains difficult. In recent years, especially with the assistance of international voluntary cardiac organizations, efforts have increased to provide cardiac surgical services to this underserved population. In this case series, the authors describe outcomes in 30 infants surgically treated for patent ductus arteriosus between 2013 and 2019 at an emerging cardiac center in Nigeria (9 male [30%] and 21 female [70%]; mean [SD] age, 8.2 [3.01] months; mean [SD] weight, 5.3 [1.52] kg; mean [range] weight deficit, 34.5% [15%-60%]). All the infants presented with patent ductus arteriosus as the main cardiac lesion, and 4 (13%) were syndromic. The mean (SD) patent ductus arteriosus diameter was 4.73 (1.46) mm. Surgical closure was completed in 29 infants; 1 died before surgery. No procedure-related deaths occurred, but 2 cases of trivial residual patent ductus arteriosus were recorded. Overall, surgical outcomes were excellent, with acceptable mortality rates. Perioperative care will continue to improve as the center is built to a self-sustaining capacity. Findings of this research at this emerging cardiac center in a developing country are a testament to the positive contribution made by international voluntary cardiac missions.

Interventions to prevent hypothermia in extremely preterm low-weight infants undergoing cardiac catheterisation

BackgroundIn January 2019, a new device called the Amplatzer Piccolo Occluder was approved by the US Food and Drug Administration for percutaneous closure of patent ductus arteriosus in infants weighing...

Use of the Medtronic Microvascular Plug 7Q for transcatheter closure of large patent ductus arteriosus in infants weighing less than 2.5 kg.

BackgroundThe sole Food and Drug Administration‐approved device for transcatheter closure of the patent arterial duct in premature infants is indicated for patent ductus arteriosus (PDAs) ≤ 4 mm in diameter. We report a two‐center experience with transcatheter closure of large PDAs (>4 mm) in infants weighing <2.5 kg using the Microvascular Plug 7Q (MVP‐7Q) device.MethodsThis is a retrospective review of departmental databases and medical charts to define patient cohort and report demographic, procedural, and follow‐up data.ResultsTwenty‐two patients (12 male) with a median gestational age and birthweight of 25.5 weeks (interquartile range [IQR] = 24–28) and 800 g (572–1075), respectively, underwent attempted PDA occlusion with the MVP‐7Q using a transvenous approach. The median age and weight at the time of PDA occlusion was 32 days (IQR = 24–28) and 1100 g (IQR = 960–1700), respectively. The median PDA length was 12 mm (IQR = 11–12.65). The median PDA diameters at the aortic and pulmonary ends were 5.1 (IQR = 4.9–5.5) and 4.8 mm (IQR = 4.6–5.3), respectively. Successful device occlusion was achieved in 20 patients (91%). There were two failed attempts: One due to inappropriate sizing, and the other secondary to left pulmonary artery stenosis. There were no procedural complications and no residual shunting on follow‐up.ConclusionsThe MVP‐7Q is safe and effective for transcatheter closure of large (>4 mm) PDAs in infants <2.5 kg. The lack of retention disks may help with avoiding impingement on surrounding vessels.

Abstract 11887: High Agreement Between 2D and 3D Echocardiography in Measuring Dimensions of the Patent Ductus Arteriosus in Infants

Introduction: The patent ductus arteriosus (PDA) is a common lesion in infants. Two-dimensional echocardiography (2DE) is standard for PDA imaging. Three-dimensional echocardiography (3DE) is often used for complex anatomy and for procedural planning. Very limited data exist on use of 3DE of the PDA in infants despite its value in planning interventions. We aim to determine the agreement between 2DE and 3DE in measuring PDAs in infants. Hypothesis: Significant agreement exists between 2DE and 3DE for PDA measurements. Methods: Infants with a known PDA underwent 2DE and 3DE imaging by an IRB-approved protocol. Subjects were &lt;1 year old, &gt;32 weeks corrected gestation (CGA), &gt;1kg, and clinically stable. Parasternal short axis (PSAX) and suprasternal notch (SSN) PDA images were taken. Two blinded observers measured the pulmonic (PA) and aortic (Ao) end of the PDA. Interobserver variability was assessed by interclass correlation (ICC), Bland-Altman (BA), and coefficient of variability (COA). 2DE to 3DE agreement was assessed by BA. Results: For 19 subjects acquired, median CGA 38.0 weeks (IQR 35.6-39.1), median weight 3.07kg (IQR 2.83-4.34). ICC for 2DE and 3DE in all views was &gt;0.98 with narrow limits of agreement (LOA) (Table 1). BA showed low bias and narrow LOA. COA was &lt;3.6%. Paired 2DE-3DE comparison had low bias and narrow LOA (Table 2). Conclusions: PDA measures by 2DE and 3DE have strong interobserver agreement. Paired 2DE-3DE measures show low bias and variability. A larger cohort will test agreement with variable subject size, ductal size &amp; type, and compare to angiography. Preliminary data show promise for 3DE in future use for PDA procedural planning.

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams.

Persistent patent ductus arteriosus (PDA) is very common in preterm infants, especially in extremely preterm infants. Despite significant advances in management of these vulnerable infants, there has been no consensus on management of PDA—when should we treat, who should we treat, how should we treat and in fact there is no agreement on how we should define a hemodynamically significant PDA. Medical management with non-steroidal anti-inflammatory drugs (NSAIDs) remains the first line of therapy with moderate success rate in closing the PDA. Paracetamol has been reported to be a safe and equally effective medical therapy for closure of PDA. However, additional studies on its long-term safety and efficacy in extremely low birth weight infants are needed before paracetamol can be recommended as standard treatment for a PDA in preterm infants. Surgical ligation of PDA is not without an increased risk of mortality and co-morbidities. Recently, there has been a significant interest in percutaneous transcatheter closure of PDA in preterm infants, including extremely low birth weight infants. Transcatheter PDA closure in preterm ELBW infants is technically feasible with high PDA occlusion success rates and acceptable complication rates as compared to surgical ligation. Many centers have reported promising early- and mid-term follow-up results. However, they need to be further tested in the prospective well-designed studies and randomized controlled trials comparing the results and outcomes of this technique with current treatment strategies including medical treatment before they can be used as the new standard of care for PDA closure in extremely low birth weight infants.

Determination of the Prevalence of Patent Ductus Arteriosus in Infants with Very Low Birth Weight Admitted in Hospital during 2011-2016

Determination of the Prevalence of Patent Ductus Arteriosus in Infants with Very Low Birth Weight Admitted in Hospital during 2011-2016

Миниинвазивное закрытие дефектов межжелудочковой перегородки с открытым артериальным протоком у детей до 1 года.

Миниинвазивное закрытие дефектов межжелудочковой перегородки с открытым артериальным протоком у детей до 1 года.

Emergency and sub-emergency transcatheter closure of patent ductus arteriosus in infants

Objective To explore the effects and follow-up findings of emergency and sub-emergency transcatheter closure of patent ductus arteriosus (PDA) in infants. Methods A retrospective study was performed to analyze the effects, complications, immediate and mid-term follow-up outcomes in 12 infants with PDA from Guangzhou Women and Children's Medical Center between March 2008 and April 2014 in order to evaluate the efficacy and safety of transcatheter closure of PDA in infants.All cases were diagnosed preoperatively as pneumonia, and 10 cases had congestive heart failure.Pulmonary symptoms showed no obvious change after regular internal medicine therapies. Results Twelve devices (100%) were successfully implanted.Echocardiogram was performed 3 days after the procedures and showed no residual shunt in any case.Left ventricular end-diastolic dimension[(31.3±5.4) mm], left atrial diameter[(18.2±3.4) mm], left ventricular ejection fraction(LVEF)[(56.8±8.7)%], pulmonary artery systolic pressure and mitral regurgitation were decreased or alleviated in contrast with those before the procedures(all P 0.05). Left pulmonary artery blood flow velocity was increased in 3 cases.The maximal descending aorta blood flow velocity was 1.9 m/s and 2.4 m/s respectively in 2 cases, blood flow velocity of left pulmonary artery and descending aorta were blow 2.3 m/s, pressure gradient was less than 2.9 kPa in 23-28 months after the procedure and no patient received any other intervention. Conclusions Emergency and sub-emergency transcat-heter closure of PDA in infants is safe and feasible, but long-term follow-up is needed in patients with increased left pulmonary artery blood flow velocity and/or descending aorta blood flow velocity. Key words: Patent ductus arteriosus; Interventional therapy; Emergency and sub-emergency; Infant

Surgery for patent ductus arteriosus in infants with very low birth weight. ECVSI

Surgery for patent ductus arteriosus in infants with very low birth weight. ECVSI

Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low-birth-weight infants.

In preterm newborns, the ductus arteriosus frequently fails to close and the infants require medical or surgical closure of the patent ductus arteriosus (PDA). A PDA can be treated surgically or medically with one of two prostaglandin inhibitors, indomethacin or ibuprofen. Case reports suggest that paracetamol may be an alternative for the closure of a PDA. Concerns have been raised that in neonatal mice paracetamol may cause adverse effects on the developing brain, and an association between prenatal exposure to paracetamol and later development of autism or autism spectrum disorder has been reported. To determine the efficacy and safety of intravenous or oral paracetamol compared with placebo or no intervention, intravenous indomethacin, intravenous or oral ibuprofen, or with other cyclo-oxygenase inhibitors for closure of a PDA in preterm or low-birth-weight infants. We used the standard search strategy of the Cochrane Neonatal Review Group. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, EMBASE and CINAHL. We searched abstracts from the meetings of the Pediatric Academic Societies and the Perinatal Society of Australia and New Zealand. We searched clinicaltrials.gov; controlled-trials.com; anzctr.org.au; World Health Organization International Clinical Trials Registry Platform at who.int/ictrp for ongoing trials and the Web of Science for articles quoting identified randomised controlled trials. We searched the first 200 hits on Google Scholar(TM) to identify grey literature. All searches were conducted in December 2013. A repeat search of MEDLINE in August 2014 did not identify any new trials. We identified two randomised controlled trials (RCTs) that compared oral paracetamol to oral ibuprofen for the treatment of an echocardiographically diagnosed PDA in infants born preterm (≤ 34 weeks postmenstrual age (PMA)). We performed data collection and analyses in accordance with the methods of the Cochrane Neonatal Review Group. Two unmasked studies of treatment of PDA that enrolled 250 infants were included. The sequence of randomisation and the allocation to treatment groups were concealed in both studies. In one study the cardiologist assessing PDA closure was blinded to group allocation of the infant. In the other study it was not stated if that was the case or not. The quality of the trials, using GRADE, was low for the primary outcome of PDA closure and moderate for all other important outcomes. There was no significant difference between treatment with oral paracetamol versus oral ibuprofen for failure of ductal closure after the first course of drug administration (typical relative risk (RR) 0.90, 95% confidence interval (CI) 0.67 to 1.22; typical risk difference (RD) -0.04, 95% CI -0.16 to 0.08; I(2) = 0 % for RR and 23% for RD).There were no significant differences between the paracetamol and the ibuprofen groups in the secondary outcomes except for 'duration for need of supplemental oxygen' (mean difference -12 days, 95% CI -23 days to -2 days; 1 study, n = 90) and for hyperbilirubinaemia (RR 0.57, 95% CI 0.34 to 0.97; RD -0.15, 95% CI -0.29 to -0.01; number needed to treat to benefit (NNTB) 7, 95% CI 3 to 100 in favour of paracetamol; 1 study, n = 160). Although a limited number of infants with a PDA have been studied in randomised trials of low to moderate quality according to GRADE, oral paracetamol appears to be as effective in closing a PDA as oral ibuprofen. In view of a recent report in mice of adverse effects on the developing brain from paracetamol, and another report of an association between prenatal paracetamol and the development of autism or autism spectrum disorder in childhood, long-term follow-up to at least 18 to 24 months postnatal age must be incorporated in any studies of paracetamol in the newborn population. Such trials are required before any recommendations for the use of paracetamol in the newborn population can be made.

Spontaneous Closure of Patent Ductus Arteriosus in an Adult Patient: A Case Report

Patent Ductus Arteriosus (PDA) is a well-described congenital heart disease in infants and children but is less commonly reported in adults. Mechanical, surgical and spontaneous closure of PDAs in infants and fetuses are common, however spontaneous closure of PDA in adults is uncommon and has not been reported in the recent literature. We present a case report of spontaneous closure of a PDA in a 49 years old patient demonstrated on cardiac computed tomography (CT).

Interventional closure of patent ductus arteriosus in infants smaller than 5000 g - single center experience of thirteen consecutive cases over 2 years

Introduction: Occlusion of patent ductus arteriosus (PDA) in small infants is in many centers still a domain of cardiac surgery that can be performed with little technical effort but still bares the risks of any open surgical therapy. Interventional therapy has recently evolved in the field of PDA occlusion. New device technology with miniaturized devices and softer, more flexible equipment require smaller introducer sheathes, may prevent distortion of the anatomy during implantation and therefore is more suitable in smaller infants.

Patent ductus arteriosus in infants &lt;28 weeks gestation

Journal of Paediatrics and Child HealthVolume 50, Issue 4 p. 323-323 Heads UpFree Access Patent ductus arteriosus in infants <28 weeks gestation First published: 03 April 2014 https://doi.org/10.1111/jpc.12533 edited by Craig Mellis ([email protected]) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat The management of patent ductus arteriosus (PDA) in preterm infants is controversial. A Danish single-centre cohort study routinely screened infants <32 weeks gestation with echocardiography for PDA on day 3 of life.1 The study assessed the association between PDA diameter and various adverse outcomes. It also distinguished between small (diameter <1.5 mm) and large PDA (≥1.5 mm) and compared infants born <28 weeks gestation with those born ≥28 weeks. Thirty-two (31%) of 104 neonates ≥28 weeks had PDA, but there was no association between PDA and adverse outcome. In contrast, PDA was present in 52 (66%) of 79 neonates <28 weeks gestation and associated with more than triple the risk of death or severe morbidity (odds ratio (OR) = 3.4, 95% confidence interval (CI) 1.1, 11). The risk was highest in infants with large PDA (≥1.5 mm), who also had an increased risk of intraventricular haemorrhage (OR = 4.2, 95% CI 1.3, 14) and bronchopulmonary dysplasia (OR = 3.7, 95% CI 1.0, 14). The authors do not suggest that PDA closure would improve outcome but suggest that routine early echocardiography could identify infants with PDA who could be enrolled in clinical trials evaluating duct closure. Reference 1 Sellmer A et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch. Dis. Child. Fetal Neonatal Ed. 2013; 98: F505– 510. Reviewer: David Isaacs, [email protected] Volume50, Issue4April 2014Pages 323-323 ReferencesRelatedInformation

Patent ductus arteriosus in infants &lt;28 weeks gestation

Journal of Paediatrics and Child HealthVolume 50, Issue 3 p. 242-243 Heads UpFree Access Patent ductus arteriosus in infants <28 weeks gestation First published: 27 March 2014 https://doi.org/10.1111/jpc.12527_2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The management of patent ductus arteriosus (PDA) in preterm infants is controversial. A Danish single-centre cohort study routinely screened infants <32 weeks gestation with echocardiography for PDA on day 3 of life.1 The study assessed the association between PDA diameter and various adverse outcomes. It also distinguished between small (diameter <1.5 mm) and large PDA (≥1.5 mm) and compared infants born <28 weeks gestation with those born ≥28 weeks. Thirty-two (31%) of 104 neonates ≥28 weeks had PDA, but there was no association between PDA and adverse outcome. In contrast, PDA was present in 52 (66%) of 79 neonates <28 weeks gestation and associated with more than triple the risk of death or severe morbidity (odds ratio (OR) = 3.4, 95% confidence interval (CI) 1.1, 11). The risk was highest in infants with large PDA (≥1.5 mm) who also had an increased risk of intraventricular haemorrhage (OR = 4.2, 95% CI 1.3, 14) and bronchopulmonary dysplasia (OR = 3.7, 95% CI 1.0, 14). The authors do not suggest that PDA closure would improve outcome but suggest that routine early echocardiography could identify infants with PDA who could be enrolled in clinical trials evaluating duct closure. Reference 1 Sellmer A et al. Arch. Dis. Child. Fetal Neonatal Ed. 2013; 98: F505– 510. CrossrefPubMedWeb of Science®Google Scholar Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au Volume50, Issue3March 2014Pages 242-243 ReferencesRelatedInformation

Comparison of Oral Ibuprofen and Intravenous Indomethacin for the Treatment of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

ObjectiveThere are few published reports concerning the efficacy of oral ibuprofen for the treatment of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Oral ibuprofen was compared to intravenous indomethacin regarding efficacy and safety in the treatment of PDA in infants weighting less than 1,000g at birth. MethodThis was a retrospective study in a single center. Data on ELBW infants who had an echocardiographically confirmed PDA were collected. The infants were treated with either intravenous indomethacin or oral ibuprofen. Rate of ductal closure, need for additional treatment, drug-related side effects or complications, and mortality were compared between the two treatment groups. Result26 infants who received indomethacin and 22 infants who received ibuprofen were studied. The overall rate of ductal closure was similar between the two treatments: it occurred in 23 of 26 infants (88.5%) treated with indomethacin, and in 18 of 22 infants (81.8%) treated with ibuprofen (p=0.40). The rate of surgical ligation (11.5% versus 18.2%; p=0.40) did not differ significantly between the two treatment groups. No significant difference was found in post-treatment serum creatinine concentrations between the two groups. There were no significant differences regarding additional side effects or complications. ConclusionIn ELBW infants, oral ibuprofen is as efficacious as intravenous indomethacin for the treatment of PDA. There were no differences between the two drugs with respect to safety. Oral ibuprofen could be used as an alternative agent for the treatment of PDA in ELBW infants.

Comparison of oral ibuprofen and intravenous indomethacin for the treatment of patent ductus arteriosus in extremely low birth weight infants

ObjectiveThere are few published reports concerning the efficacy of oral ibuprofen for the treatment of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Oral ibuprofen was compared to intravenous indomethacin regarding efficacy and safety in the treatment of PDA in infants weighting less than 1,000g at birth. MethodThis was a retrospective study in a single center. Data on ELBW infants who had an echocardiographically confirmed PDA were collected. The infants were treated with either intravenous indomethacin or oral ibuprofen. Rate of ductal closure, need for additional treatment, drug-related side effects or complications, and mortality were compared between the two treatment groups. Result26 infants who received indomethacin and 22 infants who received ibuprofen were studied. The overall rate of ductal closure was similar between the two treatments: it occurred in 23 of 26 infants (88.5%) treated with indomethacin, and in 18 of 22 infants (81.8%) treated with ibuprofen (p=0.40). The rate of surgical ligation (11.5% versus 18.2%; p=0.40) did not differ significantly between the two treatment groups. No significant difference was found in post-treatment serum creatinine concentrations between the two groups. There were no significant differences regarding additional side effects or complications. ConclusionIn ELBW infants, oral ibuprofen is as efficacious as intravenous indomethacin for the treatment of PDA. There were no differences between the two drugs with respect to safety. Oral ibuprofen could be used as an alternative agent for the treatment of PDA in ELBW infants.