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Kim S, Kim SY, Shin JA, Youn YA. Risk factors for PDA ligation and neurodevelopmental outcomes at corrected 18-24 months in very low birth weight infants. BMC Pediatr 2024; 24:376. [PMID: 38822298 PMCID: PMC11140864 DOI: 10.1186/s12887-024-04860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is commonly encountered morbidity which often occurs as up to 60% of extremely preterm infants born at < 29 weeks gestational age (GA). PURPOSE This study aims to assess the clinical risk factors associated with PDA ligation among very low birth weight infants (VLBWI) and evaluate the neurodevelopmental outcomes of those who underwent PDA ligation. METHODS A total of 540 VLBWI were initially diagnosed with PDA in our 50-bed level IV NICU at Seoul St. Mary's Hospital, The Catholic University of Korea, between January 2015 and June 2023. Among these 540 VLBWI with PDA, only 221 had consistent hemodynamically significant (hs) PDA which required intervention including fluid restriction, medical treatment, or surgical ligation. In this study, only those 221 VLBWI with hsPDA who underwent neurodevelopmental assessment at corrected 18-24 months of age were included in this study analysis. RESULTS Out of 221 VLBWI diagnosed with hemodynamically significant (hs) PDA, 133 (60.2%) underwent PDA ligation, while the remaining 88 (39.8%) had their hs PDAs closed either medically or with fluid restriction. The mean gestational age and birth weight were significantly lower in PDA ligation group compared to no PDA ligation group (27.02 ± 2.17 vs. 27.98 ± 2.36, 907.31 ± 258.36 vs. 1006.07 ± 283.65, p = 0.001, 0.008). Resuscitation including intubation at delivery and intraventricular hemorrhage (IVH) (grade ≥ 3) were significantly higher in PDA ligation group. The clinical outcomes in the PDA ligation group revealed significantly worse oucomes compared to the no PDA ligation group. Both resuscitation, including intubation at delivery, and IVH (grade ≥ 3), consistently exhibited an increased risk for PDA ligation in a multivariable logistic regression analysis. Concerning neurodevelopmental outcomes, infants who underwent PDA ligation demonstrated significantly lower cognitive scores. However, only IVH (grade ≥ 3) and PVL were consistently associated with an increased risk of abnormal neurodevelopment at the corrected age of 18-24 months. CONCLUSION In our study, despite the consistent association between cognitive developmental delays in VLBWI who underwent PDA ligation, we observed that sicker and more vulnerable VLBWIs, specifically those experincing severe IVH, consistently exhibited an increased risk for both PDA ligation and abnormal neurodevelopment at the corrected age of 18-24 months.
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Affiliation(s)
- Sol Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sae Yun Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ju-Ae Shin
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young-Ah Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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2
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Kaur M, Gupta PP, Jain A, Kaur G, Kaur A, Bansal M. Investigating multifaceted action of ibuprofen derivatives towards cox isozymes and interleukin-6 (IL-6) site correlating with various target sites. J Biomol Struct Dyn 2024; 42:2410-2423. [PMID: 37154526 DOI: 10.1080/07391102.2023.2209645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
The multifaceted action of new ibuprofen analogs has been investigated against inflammation, neurological and pro-inflammation factors. On the basis of ADMET (absorption, distribution, metabolism, excretion, and toxicity) analysis, molecular docking as well as molecular dynamics simulation, compound 3 was thought to have good anti-inflammatory activity. As the presence of structural interactions such as conventional hydrogen bonds and electrostatic interactions through the nitrogen atoms of the linker in compound 3 gave strong evidence of its potency. The major finding of the current work is that the presence of appropriate number of hetero atoms (NH, OH) in a compound makes it more efficient than the number of labile groups (i.e., hydroxyl groups). Additionally, the position of hetero atoms in a compound and orientation also play a vital role in its efficacy. It was also screened for in vitro anti-inflammatory activity by membrane stability method, where it has shown 90.8% protection of RBC hemolysis. Thus, compound 3 with effective structural features may have good anti-inflammatory activity.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Mandeep Kaur
- Department of Chemistry, Punjabi University, Patiala, India
| | - Pramodkumar P Gupta
- School of Biotechnology and Bioinformatics, D Y Patil Deemed to be University, Navi Mumbai, Maharashtra, India
| | - Anmol Jain
- Department of Chemistry, Punjabi University, Patiala, India
| | - Gurmeet Kaur
- Department of Chemistry, Punjabi University, Patiala, India
| | - Amandeep Kaur
- Department of Chemistry, Punjabi University, Patiala, India
| | - Manisha Bansal
- Department of Chemistry, Punjabi University, Patiala, India
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3
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Glover CD, Berkenbosch JW, Taylor MB, Patel NV, Kaelin B, Gibson BHY, Zhong J. A Multi-Center Evaluation of the Pharmacokinetics and Safety of Intravenous Ibuprofen in Infants 1-6 Months of Age. Paediatr Drugs 2023; 25:585-593. [PMID: 37294477 DOI: 10.1007/s40272-023-00576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Enteral ibuprofen was first approved as a prescription drug in 1974 for the US market. An intravenous (IV) ibuprofen formulation is approved for use in children older than 6 months of age, but there are limited studies specifically evaluating the pharmacokinetics and safety in children 1-6 months of age. AIMS The primary purpose of this study was to evaluate the pharmacokinetics of IV ibuprofen in infants younger than 6 months of age. The secondary objective was to evaluate the safety of single and repeated doses of IV ibuprofen in infants younger than 6 months of age. METHODS This was an industry-sponsored multi-center study. Institutional Review Board approval and informed parental consent were obtained prior to enrollment. Hospitalized neonates and infants younger than 6 months of age with fever or expected postoperative pain were eligible. Enrolled patients received 10 mg/kg of IV ibuprofen every 6 h, with up to four doses per day. Patients were randomized to two sparse sampling technique pharmacokinetic sample time groups. Group 1 samples were drawn at 0, 30 min, and 2 h, while group 2 samples were drawn at 0 min, 1, and 4 h after administration. RESULTS A total of 24 children were enrolled in the study, with 15 male patients and 9 female patients. The median age of the cohort was 4.4 months (range 1.1-5.9 months), and the median weight was 5.9 kg (range 2.3-8.8 kg). The arithmetic mean and standard error for peak plasma ibuprofen concentration was 56.28 ± 2.77 µg/mL. Plasma levels declined rapidly with a mean elimination half-life of 1.30 h. Time to peak ibuprofen effect and concentration were similar when compared with older pediatric patients. Clearance and volume of distribution were also similar to those reported in older pediatric patients. No drug-related adverse events were reported. CONCLUSIONS The pharmacokinetic and short-term safety profiles of IV ibuprofen in pediatric patients 1-6 months of age are comparable to those in children older than 6 months of age. TRIAL REGISTRATION Clinicaltrials.gov Trial Registration number and date: NCT02583399-Registered July 2017.
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Affiliation(s)
- Chris D Glover
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030-2399, USA
| | - John W Berkenbosch
- "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY, USA
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, 231 E. Chestnut St, N-97, Louisville, KY, 40202, USA
| | - Mary B Taylor
- Department of Pediatrics, Suzan B. Thames Chair, Pediatric Critical Care and Pediatric Cardiology, Children's of Mississippi, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Nihar V Patel
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030-2399, USA
| | - Byron Kaelin
- Clinical Operations, Cumberland Pharmaceuticals Inc., 1600 West End Avenue, Suite 1300, Nashville, TN, 37203, USA
| | - Breanne H Y Gibson
- Clinical Operations, Cumberland Pharmaceuticals Inc., 1600 West End Avenue, Suite 1300, Nashville, TN, 37203, USA
| | - John Zhong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health of Dallas, 1935 Medical District Drive, Suite D2085, Dallas, TX, 75235, USA.
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4
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Ferrari D, Lundgren S, Holmberg J, Edner A, Ekstrand C, Nyman G, Bondesson U, Hagman R. Concentration of carprofen in the milk of lactating bitches after cesarean section and during inflammatory conditions. Theriogenology 2022; 181:59-68. [DOI: 10.1016/j.theriogenology.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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5
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Katsaras DN, Katsaras GN, Chatziravdeli VI, Papavasileiou GN, Touloupaki M, Mitsiakos G, Doxani C, Stefanidis I, Dardiotis E. Comparative safety and efficacy of paracetamol versus non-steroidal anti-inflammatory agents in neonates with patent ductus arteriosus: a systematic review and meta-analysis of randomized controlled trials. Br J Clin Pharmacol 2022; 88:3078-3100. [PMID: 35203104 DOI: 10.1111/bcp.15291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/05/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022] Open
Abstract
AIM Ibuprofen and indomethacin are the preferred drug treatment for patent ductus arteriosus (PDA) in preterm neonates. The comparative safety and efficacy of paracetamol as an alternative has not yet been well-established. The aim of our study was to define the comparative efficacy and safety of paracetamol versus ibuprofen and indomethacin for PDA METHODS: We performed a systematic literature search in Pubmed, Scopus and Cochrane databases on randomized controlled trials comparing the efficacy and/or the safety of paracetamol versus ibuprofen and/or indomethacin and meta-analyzed the available data. RESULTS There were 1718 neonates from 20 eligible studies. Paracetamol did not differ from ibuprofen or indomethacin regarding the primary [OR: 0.93 (95% CI: 0.69-1.26), p-value: 0.650, when compared to ibuprofen, and OR: 0.78 (95% CI: 0.20-3.02), p-value: 0.716, when compared to indomethacin] and overall [OR: 1.17 (95% CI: 0.82-1.66), p-value: 0.394, when compared to ibuprofen, and OR: 1.12 (95% CI: 0.58-2.15), p-value: 0.733, when compared to indomethacin] PDA closure rates. Paracetamol resulted in significantly reduced risk of oliguria and a tendency towards less gastrointestinal bleeding. CONCLUSION There was no significant difference between paracetamol and ibuprofen or indomethacin in the PDA closure rates. However, paracetamol caused less adverse effects.
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Affiliation(s)
- Dimitrios N Katsaras
- Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.,Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.,Sixth Cardiology Department, "Hygeia" Hospital, Marousi, Athens, Greece
| | - Georgios N Katsaras
- Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.,Second Neonatal Department and Neonatal Intensive Care Unit, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece.,Paediatric Department, General Hospital of Pella - Hospital Unit of Edessa, Edessa, Greece
| | | | | | - Maria Touloupaki
- Sixth Cardiology Department, "Hygeia" Hospital, Marousi, Athens, Greece
| | - Georgios Mitsiakos
- Second Neonatal Department and Neonatal Intensive Care Unit, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Chrysoula Doxani
- Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
| | - Ioannis Stefanidis
- Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.,Department of Nephrology, University of Thessaly School of Medicine, Larissa, Greece
| | - Efthimios Dardiotis
- Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.,Department of Neurology, Laboratory of Neurogenetics, University Hospital of Larissa, University of Thessaly School of Medicine, Larissa, Greece
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6
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Samiee-Zafarghandy S, van Donge T, Fusch G, Pfister M, Jacob G, Atkinson A, Rieder MJ, Smit C, Van Den Anker J. Novel strategy to personalise use of ibuprofen for closure of patent ductus arteriosus in preterm neonates. Arch Dis Child 2022; 107:86-91. [PMID: 33975823 DOI: 10.1136/archdischild-2020-321381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/08/2021] [Accepted: 04/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Exploration of a novel therapeutic drug monitoring (TDM) strategy to personalise use of ibuprofen for closure of patent ductus arteriosus (PDA) in preterm neonates. DESIGN Prospective, single-centre, open-label, pharmacokinetics study in preterm neonates. SETTING Neonatal intensive care unit at McMaster Children's Hospital. PATIENTS Neonates with a gestational age ≤28+6 weeks treated with oral ibuprofen for closure of a PDA. METHODS Population pharmacokinetic parameters, concentration-time profiles and exposure metrics were obtained using pharmacometric modelling and simulation. MAIN OUTCOME MEASURE Association between ibuprofen plasma concentrations measured at various sampling time points on the first day of treatment and attainment of the target exposure over the first 3 days of treatment (AUC0-72h >900 mg·hour/L). RESULTS Twenty-three preterm neonates (median birth weight 780 g and gestational age 25.9 weeks) were included, yielding 155 plasma ibuprofen plasma samples. Starting from 8 hours' postdose on the first day, a strong correlation between ibuprofen concentrations and AUC0-72h was observed. At 8 hours after the first dose, an ibuprofen concentration >20.5 mg/L was associated with a 90% probability of reaching the target exposure. CONCLUSION We designed a novel and practical TDM strategy and have shown that the chance of reaching the target exposure (AUC0-72h >900 mg·hour/L) can be predicted with a single sample collection on the first day of treatment. This newly acquired knowledge can be leveraged to personalise ibuprofen dosing regimens and improve the efficacy of ibuprofen use for pharmacological closure of a PDA.
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Affiliation(s)
| | - Tamara van Donge
- Department of Pediatric Pharmacology and Pharmacometrics, UKBB Universitäts-Kinderspital, Basel, Switzerland
| | - Gerhard Fusch
- Division of Neonatology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Marc Pfister
- Department of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland
| | - George Jacob
- Division of Neonatology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Andrew Atkinson
- Pädiatrische klinische Pharmakologie, Universitäts-Kinderspital beider Basel, Basel, Switzerland
| | - Michael J Rieder
- Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, Ontario, Canada
| | - Cornelis Smit
- Department of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland
| | - John Van Den Anker
- Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland.,Division of Clinical Pharmaoclogy, Children's National Health System, Washington, DC, USA
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7
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Shahmirzadi G, Nooripour S, Ziari A, Danaei N. Comparison of Gastrointestinal Complications of Paracetamol and Ibuprofen in the Management of Infants with Patent Ductus Arteriosus: A Randomized Clinical Trial Study. Int J Prev Med 2021; 12:48. [PMID: 34211679 PMCID: PMC8223912 DOI: 10.4103/ijpvm.ijpvm_387_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Patent ductus arteriosus (PDA) is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with ibuprofen; however, this drug is associated with many contraindications and potential side-effects. In the past years, paracetamol has been proposed for the treatment of PDA. This study was designed to evaluate the efficacy and gastrointestinal complications of paracetamol and ibuprofen for the pharmacological closure of PDA in preterm infants. Methods: In a clinical trial study, 40 preterm infants with echocardiographically confirmed PDA were randomly assigned to receive either paracetamol (n = 23; 15 mg/kg every 6 h for 2 days) or ibuprofen (n = 17; initial dose of 10 mg/kg, followed by 5 mg/kg every 12 h for 2 days). The neonates matched for gestational age and weight. We used t-test for parametric, Chi-square for categorial, and Wilcoxson for nonparametric variables. Significant level was considered less than 0.05. Results: Platelet count, BUN and creatinine levels, and closure of PDA had not significant difference between two groups (P > 0.05). Incidence and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen (P < 0.05). Conclusions: There were no differences in the rate of PDA closure between the two drugs, but with respect to complications, rate and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen. Therefore, paracetamol could not be used as a proper alternative agent for ibuprofen in the treatment of PDA in preterm infants.
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Affiliation(s)
- Gohar Shahmirzadi
- Department of Pediatric, Semnan University of Medical Science, Semnan, Iran.,Students Research Committee, Semnan University of Medical Science, Semnan, Iran
| | | | - Abbas Ziari
- Social Determinants of Health Research Center, Semnan University of Medical Science, Semnan, Iran
| | - Navid Danaei
- Department of Pediatric, Semnan University of Medical Science, Semnan, Iran
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8
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Prasad JD, Gunn KC, Davidson JO, Galinsky R, Graham SE, Berry MJ, Bennet L, Gunn AJ, Dean JM. Anti-Inflammatory Therapies for Treatment of Inflammation-Related Preterm Brain Injury. Int J Mol Sci 2021; 22:4008. [PMID: 33924540 PMCID: PMC8069827 DOI: 10.3390/ijms22084008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of preterm brain injury, there are no established neuroprotective strategies to prevent or alleviate mild-to-moderate inflammation-related brain injury. Perinatal infection and inflammation have been shown to trigger acute neuroinflammation, including proinflammatory cytokine release and gliosis, which are associated with acute and chronic disturbances in brain cell survival and maturation. These findings suggest the hypothesis that the inhibition of peripheral immune responses following infection or nonspecific inflammation may be a therapeutic strategy to reduce the associated brain injury and neurobehavioral deficits. This review provides an overview of the neonatal immunity, neuroinflammation, and mechanisms of inflammation-related brain injury in preterm infants and explores the safety and efficacy of anti-inflammatory agents as potentially neurotherapeutics.
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Affiliation(s)
- Jaya D. Prasad
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Katherine C. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Joanne O. Davidson
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia;
| | - Scott E. Graham
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand;
| | - Mary J. Berry
- Department of Pediatrics and Health Care, University of Otago, Dunedin 9016, New Zealand;
| | - Laura Bennet
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Alistair J. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Justin M. Dean
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
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9
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Seraj F, Khan KM, Khan A, Ali M, Khalil R, Ul-Haq Z, Hameed S, Taha M, Salar U, Perveen S. Biology-oriented drug synthesis (BIODS), in vitro urease inhibitory activity, and in silico studies on ibuprofen derivatives. Mol Divers 2020; 25:143-157. [PMID: 31965436 DOI: 10.1007/s11030-019-10032-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/30/2019] [Indexed: 11/25/2022]
Abstract
Novel ibuprofen derivatives 1-19 including ibuprofen hydrazide 1, and substituted thiourea derivatives 2-19 were synthesized and characterized by EI-MS, FAB-MS, HREI-MS, HRFAB-MS, 1H-, and 13C-NMR spectroscopic techniques. The synthetic molecules 1-19 were examined for their in vitro urease inhibition and were found to display a diversified degree of inhibitory potential in the range of IC50 = 2.96-178 μM as compared to the standard thiourea (IC50 = 21.32 ± 0.22 μM). Out of nineteen, thirteen derivatives 2-4, 6, 7, 9, 11-15, 17, and 18 demonstrated remarkable inhibitory activity with IC50 values of 2.96 ± 1.11 to 16.1 ± 1.07 μM, compound 5 exhibited moderate inhibition with IC50 value of 37.3 ± 0.41 μM, whereas, compounds 1, 8, and 10 demonstrated weak inhibition against urease enzyme. Almost all structural features are participating in the activity; however, limited structure-activity relationship was discussed on the basis of different structural features, i.e., different functional groups and their positions at aryl part. In addition, molecular docking study was performed in order to understand the ligands binding interactions with the active site of urease enzyme.
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Affiliation(s)
- Faiza Seraj
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Khalid Mohammed Khan
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
- Department of Clinical Pharmacy, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, P.O. Box 31441, Dammam, Saudi Arabia.
| | - Ajmal Khan
- UoN Chair of Oman's Medicinal Plants and Marine Natural Products, University of Nizwa, P.O. Box 33, 616, Birkat al Mauz, Nizwa, Oman
| | - Muhammad Ali
- UoN Chair of Oman's Medicinal Plants and Marine Natural Products, University of Nizwa, P.O. Box 33, 616, Birkat al Mauz, Nizwa, Oman
| | - Ruqaiya Khalil
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Zaheer Ul-Haq
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Shehryar Hameed
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Muhammad Taha
- Department of Clinical Pharmacy, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, P.O. Box 31441, Dammam, Saudi Arabia
| | - Uzma Salar
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Shahnaz Perveen
- PCSIR Laboratories Complex, Karachi, Shahrah-e-Dr. Salimuzzaman Siddiqui, Karachi, 75280, Pakistan
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10
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Sena GDS, Sampaio SSS, Torres VB, Azevedo IG, Arrais NMR, Bezerra IFD, Pereira SA. Characteristics of Congenital Heart of Premature Newborns. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n3p193-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractCongenital heart disease is considered the most common malformation found in neonatology. The aim of this study was to characterize the congenital heart diseases of premature newborns in the Neonatal Intensive Care Unit (NICU) of a high-risk maternity unit. This was an observational retrospective, descriptive character study carried out in a maternity school, reference in high-risk gestation in the state of Rio Grande do Norte. The study was carried out with premature infants admitted to NICU, who presented some cardiological findings when performing the echocardiogram examination. Data collection was performed through the records of infants hospitalized from December 2016 to December 2017. A total of 371 records were evaluated. Fifty eight infants were diagnosed with congenital heart disease, and 38 of them had Persistence of the ductus arteriosus. The main diagnosed cardiopathies caused low pulmonary flow. About half of the pregnant women with cardiac infants presented some complications during pregnancy, and the most frequent was Urinary Tract Infection; 55 infants needed some ventilatory support, 14 had at least one extubation failure during the hospitalization period, and 8 presented atelectasis. Persistence of the ductus arteriosus was the most common cardiologic finding, and the most frequent congenital heart diseases were those that decreased pulmonary flow, diagnosed mostly in premature infants who needed some ventilation support, but who were discharged from hospital.Keywords: Infant, Premature. Intensive Care Units, Neonatal. Neonatology.ResumoCardiopatias congênitas (CC) são consideradas as malformações mais comuns encontradas na neonatologia. O objetivo deste estudo foi caracterizar as CC de recém-nascidos prematuros em Unidade de Terapia Intensiva Neonatal (UTIN) de uma maternidade de alto risco. Tratase de um estudo observacional retrospectivo, de caráter descritivo, realizado em uma maternidade escola, referência em gestação de alto risco do estado do Rio Grande do Norte. O estudo foi realizado com os bebês prematuros admitidos na UTIN, que apresentaram algum achado cardiológico ao realizar o exame de ecocardiograma. A coleta de dados foi realizada através dos prontuários dos bebês internados no período de dezembro de 2016 a dezembro de 2017. Foram avaliados 371 prontuários, sendo elencados para o estudo 58 bebês, 38 apresentaram persistência do canal arterial (PCA) e foram alocados no grupo PCA e 20 apresentaram outro tipo de CC e foram alocados no grupo CC. 55 bebês necessitaram do uso de algum suporte ventilatório, 14 apresentaram pelo menos uma falha de extubação durante o período de internação e 8 apresentaram atelectasia. Cerca de metade das gestantes com bebês cardiopatas apresentaram alguma intercorrência durante a gestação. A mais frequente foi à infecção do trato urinário. A PCA foi o achado cardiológico mais comum da amostra (65%) e dentre os 20 RN com diferentes CC, as que causam o baixo fluxo pulmonar foram as mais frequentes (70%), sendo encontradas em sua maioria em prematuros que necessitaram de algum suporte ventilatório, mas que receberam alta hospitalar.Palavras-chave: Recém-Nascido Prematuro. Unidade de Terapia Intensiva Neonatal. Neonatologia.
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Youn Y, Seo YM, Yum SK, Sung IK. Patent ductus arteriosus ligation on neurodevelopmental outcomes at corrected 2 years. Ital J Pediatr 2019; 45:110. [PMID: 31443661 PMCID: PMC6708147 DOI: 10.1186/s13052-019-0698-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Our aim in this study was to evaluate whether very low birth weight infants (VLBWI) ligated for patent ductus arteriosus (PDA) were associated with worse neurodevelopmental outcomes at corrected 2 years. The ligated group was subdivided into ≤2 weeks of life (early) and ligated > 2 weeks of life (late) groups and compared the in-hospital morbidities and long term outcomes. Methods Between Dec 2013 and Dec 2015, VLBWI diagnosed with hs PDA were evaluated. Results Of the 191 VLBW infants with hs PDA, 28 (14.7%) infants had surgical ligation for PDA; 11 (39%) infants had EL and 17 (61%) infants had LL. Surgical ligation of hs PDA group had higher morbidities and mortality. Among the142 (83.0%) infants of 171 VLBWI with PDA survived, infants who were ligated had significantly lower scores of Bayley Scales of Infant and Toddler Development III at corrected age of 18 months. However, among the ligated group, there was little evidence of differences between the EL and LL groups. In a multivariable logistic regression analysis, only longer exposure of hs PDA and mechanical ventilation were consistently associated with worse neurodevelopmental outcomes. Conclusion Our results suggest that surgical ligation for hs PDA may not increase risk for poor neurodevelopmental outcomes at corrected 2 years of age. The early surgical ligation may not be a risk factor.
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Affiliation(s)
- YoungAh Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea.
| | - Yu-Mi Seo
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Sook-Kyung Yum
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - In Kyung Sung
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
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Marinopoulou A, Papastergiadis E, Raphaelides SN. Inclusion Complexes of Non-Granular Maize Starch with Fatty Acids and Ibuprofen. A Comparative Study of Their Morphology and Structure. STARCH-STARKE 2018. [DOI: 10.1002/star.201800100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anna Marinopoulou
- Central Research Laboratory for the Physical and Chemical Testing of Foods; Department of Food Technology; ATEI of Thessaloniki; P.O. Box 14157400 Thessaloniki Greece
| | - Efthimios Papastergiadis
- Central Research Laboratory for the Physical and Chemical Testing of Foods; Department of Food Technology; ATEI of Thessaloniki; P.O. Box 14157400 Thessaloniki Greece
| | - Stylianos N. Raphaelides
- Central Research Laboratory for the Physical and Chemical Testing of Foods; Department of Food Technology; ATEI of Thessaloniki; P.O. Box 14157400 Thessaloniki Greece
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Aranda JV, Salomone F, Valencia GB, Beharry KD. Non-steroidal Anti-inflammatory Drugs in Newborns and Infants. Pediatr Clin North Am 2017; 64:1327-1340. [PMID: 29173788 DOI: 10.1016/j.pcl.2017.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen are used in young infants and newborns for pain and fever control, patent ductus closure, prevention of intraventricular hemorrhage, and potentially for prevention of retinopathy of prematurity. These drugs inhibit cyclooxygenase 1 (COX-1), COX-2, and peroxidases, thus, blocking prostaglandin (PG) synthesis. PGs are eicosanoids that regulate several physiologic, pathologic, and cellular processes, including vasomotor tone, platelet aggregation, sensitization of neurons to pain, and many molecular events critical to physiologic homeostasis. NSAIDs inhibit caspases and cell death. Increasing knowledge of these molecular entities may allow targeted drug development to prevent or minimize neonatal morbidities.
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Affiliation(s)
- Jacob V Aranda
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA.
| | - Fabrizio Salomone
- Neonatology and Pulmonary Rare Disease Unit, Corporate Pre-Clinical R and D, Chiesi Farmaceutici S.p.A, Largo Belloli 11/A, Parma IT-43122, Italy
| | - Gloria B Valencia
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA
| | - Kay D Beharry
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA
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Abstract
The present study examined whether early patent ductus arteriosus (PDA) surgical ligation at ≤2 weeks of life was associated with increased morbidities and mortality in very low birth weight infants (VLBWIs) who were diagnosed with hemodynamically significant (hs) PDA. Between December 2013 and December 2015, a total of 407 VLBWIs were admitted, of whom 145 (35.6%) infants were diagnosed with an hs PDA. The clinical data for these infants were retrospectively collected for analysis. Among the 145 VLBWIs with an hs PDA, 58 (40%) infants had surgical ligation for PDA; of these, 29 (50%) infants had early ligation (EL; ligation at ≤2 weeks of life) and 29 (50%) infants had late ligation (LL; ligation at ≥2 weeks of life). The mean gestational age and birth weight were significantly lower in the PDA-ligated group compared with the nonligated group. In addition, pulmonary hypertension at ≤1 week of life and neonatal seizures were significantly more prevalent in the ligated group (P < 0.05). Increased rate of ROP laser treatment, bronchopulmonary dysplasia, longer hospital stays, and longer duration of mechanical ventilation were found in ligated group (P < 0.05). However, the morbidities and mortality did not differ significantly between the EL and LL groups. Pulmonary hypertension at ≤1 week of life was significantly associated with LL (P = 0.019), which was consistently a risk factor for hs PDA ligation in our multivariable logistic regression analysis. EL was not significantly associated with increased hospital morbidities and mortality in VLBWIs with hs PDA. Pulmonary hypertension at ≤1 week of life can be a risk factor for the need for surgical ligation of hs PDA.
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Affiliation(s)
| | | | | | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Comparison of two dose regimens of ibuprofen for the closure of patent ductus arteriosus in preterm newborns. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Dornelles LV, Corso AL, Silveira RDC, Procianoy RS. Comparison of two dose regimens of ibuprofen for the closure of patent ductus arteriosus in preterm newborns. J Pediatr (Rio J) 2016; 92:314-8. [PMID: 26946966 DOI: 10.1016/j.jped.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the efficacy of intravenous ibuprofen at high (20-10-10mg/kg/dose) and low doses (10-5-5mg/kg/dose) the closure of patent ductus arteriosus in preterm newborns. METHODS A cohort study with historical control of newborns that received high- and low-dose intravenous ibuprofen, from 2010 to 2013 in a neonatal intensive care unit, for closure of the patent ductus arteriosus, documented by echocardiography. Secondary outcomes included the number of ibuprofen cycles, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, changes in renal function, and death. RESULTS Seventy-seven patients received three doses of ibuprofen for the treatment of patent ductus arteriosus, with 33 receiving high-dose and 44 low-dose therapy. The ductus closed after the first cycle in 25 (56.8%) low-dose patients and in 17 (51.5%) high-dose patients (p>0.99). Sixteen patients received a second cycle of ibuprofen, and the ductus closed in 50% after low-dose and in 60% after high-dose therapy (p>0.99). Seven patients required surgery for ductus closure, 13.6% in the low-dose group and 3% in the high-dose group (p=0.22). Thirty-nine patients developed bronchopulmonary dysplasia, 50% in the low-dose group and 51.5% in the high-dose group (p>0.99). Twenty-two (50%) low-dose patients died vs. 15 (45.5%) high-dose patients (p=0.86). CONCLUSIONS There was no difference in closure of the ductus arteriosus or occurrence of adverse effects between the two dose regimens.
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Affiliation(s)
- Laura Vargas Dornelles
- Service of Neonatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Andréa Lúcia Corso
- Service of Neonatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Rita de Cássia Silveira
- Service of Neonatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Renato Soibelmann Procianoy
- Service of Neonatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Sivanandan S, Agarwal R. Pharmacological Closure of Patent Ductus Arteriosus: Selecting the Agent and Route of Administration. Paediatr Drugs 2016; 18:123-38. [PMID: 26951240 DOI: 10.1007/s40272-016-0165-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Opinions are divided regarding the management of a persistently patent ductus arteriosus (PDA). Some of the adverse effects associated with a large hemodynamically significant duct, including prolonged ventilation, pulmonary hemorrhage, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and mortality, indicate that active management of infants with large ductal shunts may sometimes be necessary. Indomethacin and ibuprofen are the two US FDA-approved cyclooxygenase (COX) inhibitors used for the closure of a ductus in preterm babies. Both these drugs are effective in 70-80% of extremely low birthweight infants. Treatment with COX inhibitors may be associated with renal impairment, gastrointestinal hemorrhage, NEC, and spontaneous intestinal perforation when given concurrently with steroids, as well as changes in cerebrovascular auto-regulation. Ibuprofen appears to be a better choice for PDA closure, with a better side effect profile and efficacy that equals that of indomethacin. However, long-term outcome studies of ibuprofen are lacking, and prophylactic ibuprofen is ineffective in decreasing severe IVH. The choice of one drug over the other also depends on local availability of both drugs and the intravenous or enteral preparation. The oral preparation of ibuprofen appears as effective as the intravenous preparation. The use of paracetamol to close a hemodynamically significant PDA has increased in recent years. Paracetamol also decreases prostacyclin synthesis; however, unlike COX inhibitors, it does not have a peripheral vaso-constrictive effect and can be given to infants with contraindications to non-steroidal anti-inflammatory drugs. It appears to have similar efficacy based on limited data available from randomized trials. Until more data are available on efficacy, safety, and long-term outcomes, it cannot be recommended as the first choice.
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Affiliation(s)
- Sindhu Sivanandan
- Division of Neonatology, Department of Pediatrics (Newborn Health Knowledge Center (NHKC), ICMR Center for Advanced Research in Newborn Health and WHO Collaborating Centre for Newborn Training and Research, New Private Ward-1st Floor, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics (Newborn Health Knowledge Center (NHKC), ICMR Center for Advanced Research in Newborn Health and WHO Collaborating Centre for Newborn Training and Research, New Private Ward-1st Floor, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Messerer B, Grögl G, Stromer W, Jaksch W. [Pediatric perioperative systemic pain therapy: Austrian interdisciplinary recommendations on pediatric perioperative pain management]. Schmerz 2015; 28:43-64. [PMID: 24550026 DOI: 10.1007/s00482-013-1384-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many analgesics used in adult medicine are not licensed for pediatric use. Licensing limitations do not, however, justify that children are deprived of a sufficient pain therapy particularly in perioperative pain therapy. The treatment is principally oriented to the strength of the pain. Due to the degree of pain caused, intramuscular and subcutaneous injections should be avoided generally. NON-OPIOIDS The basis of systemic pain therapy for children are non-opioids and primarily non-steroidal anti-inflammatory drugs (NSAIDs). They should be used prophylactically. The NSAIDs are clearly more effective than paracetamol for acute posttraumatic and postoperative pain and additionally allow economization of opioids. Severe side effects are rare in children but administration should be carefully considered especially in cases of hepatic and renal dysfunction or coagulation disorders. Paracetamol should only be taken in pregnancy and by children when there are appropriate indications because a possible causal connection with bronchial asthma exists. To ensure a safe dosing the age, body weight, duration of therapy, maximum daily dose and dosing intervals must be taken into account. Dipyrone is used in children for treatment of visceral pain and cholic. According to the current state of knowledge the rare but severe side effect of agranulocytosis does not justify a general rejection for short-term perioperative administration. OPIOIDS In cases of insufficient analgesia with non-opioid analgesics, the complementary use of opioids is also appropriate for children of all age groups. They are the medication of choice for episodes of medium to strong pain and are administered in a titrated form oriented to effectiveness. If severe pain is expected to last for more than 24 h, patient-controlled anesthesia should be implemented but requires a comprehensive surveillance by nursing personnel. KETAMINE Ketamine is used as an adjuvant in postoperative pain therapy and is recommended for use in pediatric sedation and analgosedation.
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Affiliation(s)
- B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, LKH-Universitätsklinikum Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
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Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol 2014; 70:1313-24. [PMID: 25217187 DOI: 10.1007/s00228-014-1748-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/31/2014] [Indexed: 01/16/2023]
Abstract
PURPOSE Breastfeeding women may suffer from migraine. While we have many drugs for its treatment and prophylaxis, the majority are poorly studied in breastfeeding women. We conducted a review of the most common anti-migraine drugs (AMDs) and we determined their lactation risk. METHODS For each AMD, we collected all retrievable data from Hale's Medications and Mother Milk (2012), from the LactMed database (2014) of the National Library of Medicine, and from a MedLine Search of relevant studies published in the last 10 years. RESULTS According to our review, AMDs safe during breastfeeding are as follows: low-dose acetylsalicylic acid (ASA), ibuprofen, sumatriptan, metoprolol, propranolol, verapamil, amitriptyline, escitalopram, paroxetine, sertraline, acetaminophen, caffeine, and metoclopramide. AMDs compatible with breastfeeding but warranting caution are as follows: diclofenac, ketoprofen, naproxen, most new triptans, topiramate, valproate, venlafaxine, and cyproheptadine. Finally, high-dose ASA, atenolol, nadolol, cinnarizine, flunarizine, ergotamine, methysergide, and pizotifen are contraindicated. CONCLUSIONS According to our review, the majority of the revised AMDs were assessed to be compatible with breastfeeding.
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Affiliation(s)
- Riccardo Davanzo
- Division of Neonatology, Institute for Maternal and Child Health, IRCCS "BurloGarofolo", Trieste, Italy
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Outcomes of primary ligation of patent ductus arteriosus compared with secondary ligation after pharmacologic failure in very-low-birth-weight infants. Pediatr Cardiol 2014; 35:793-7. [PMID: 24370764 PMCID: PMC4015055 DOI: 10.1007/s00246-013-0854-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/28/2013] [Indexed: 11/03/2022]
Abstract
This study aimed to determine whether primary surgical closure of patent ductus arteriosus (PDA) is a risk factor for morbidity and mortality compared with secondary surgical ligation. The study enrolled 178 very-low-birth-weight infants. The surgical group included 34 patients who did not respond to pharmacologic intervention and eventually required ligation of their PDA as well as 35 patients who underwent direct ligation because of contraindications to the use of oral ibuprofen. The overall outcomes for the primary and secondary ligation groups were compared. The outcome during hospitalization showed no statistically significant difference in terms of morbidity and mortality between the two groups. The group that had primary ligation for PDA experienced more complications associated with premature birth such as lower gestational age and birth weight. The two groups did not differ significantly in terms of overall outcomes.
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Youn Y, Lee JY, Lee JH, Kim SY, Sung IK, Lee JY. Impact of patient selection on outcomes of PDA in very low birth weight infants. Early Hum Dev 2013; 89:175-9. [PMID: 23046995 DOI: 10.1016/j.earlhumdev.2012.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/12/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
AIM The aim of this study was to observe whether our patient selection maximized the benefits of PDA ligation by comparing the outcomes in a surgically ligated group of PDA to a medically closed group. STUDY DESIGN If a hemodynamically significant ductus arteriosus (HSDA) was found to meet both clinical and echocardiographic criteria (stage≥3), as proposed by NcNamara and Hellman, medical treatment was initiated with oral ibuprofen (maximum 2 courses). If the PDA of these patients failed to close medically, timed surgical closure was performed. RESULT Medical treatment was effective in 75 (72%) cases, and 29 (28%) patients required surgical ligation. The mean gestational age and birth weight were each significantly lower and the initial PDA shunt size was significantly larger in the surgically treated group. Additionally, the mean durations of mechanical ventilation, oxygen dependence and hospital admission were significantly longer in the surgically ligated group. However, our logistic regression analysis demonstrated no statistically significant difference in the outcomes of hospitalization (CLD, NEC, ARF, sepsis, IVH, ROP, PVL and death) between the two groups. CONCLUSION Comprehensive HSDA patient selection may maximize the benefits of timed PDA ligation without adverse outcomes in very low birth weight infants.
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Affiliation(s)
- YoungAh Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Yang L, Zhang B, Yi J, Liang J, Liu Y, Zhang LM. Preparation, characterization, and properties of amylose-ibuprofen inclusion complexes. STARCH-STARKE 2013. [DOI: 10.1002/star.201200161] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Yang EM, Song ES, Choi YY. Comparison of oral ibuprofen and intravenous indomethacin for the treatment of patent ductus arteriosus in extremely low birth weight infants. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yang EM, Song ES, Choi YY. Comparison of oral Ibuprofen and intravenous indomethacin for the treatment of patent ductus arteriosus in extremely low birth weight infants. J Pediatr (Rio J) 2013; 89:33-9. [PMID: 23544808 DOI: 10.1016/j.jped.2013.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/28/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE There 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. METHOD This 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. RESULT 26 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. CONCLUSION In 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.
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Affiliation(s)
- Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Oral ibuprofen versus intravenous indomethacin for closure of patent ductus arteriosus in very low birth weight infants. Pediatr Neonatol 2012; 53:346-53. [PMID: 23276438 DOI: 10.1016/j.pedneo.2012.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/31/2011] [Accepted: 03/14/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose of this study is to compare the effects and complications of pharmacologic closure of patent ductus arteriosus (PDA) by intravenous indomethacin or oral ibuprofen in neonates weighing <1500 g at birth [very low birth weight (VLBW) infants]. METHODS This is a retrospective study of infants treated with intravenous indomethacin (0.2 mg/kg initially followed by two doses at 24-hour intervals) or oral ibuprofen (10 mg/kg initially followed an interval of 24 hours by two doses of 5 mg/kg) for symptomatic PDA in a neonatal intensive care unit at a medical center in Taiwan during the period of January 2005 to December 2010. RESULTS A total of 88 infants received indomethacin and 52 received oral ibuprofen. Among the survivors, the closure rate without surgical ductal ligation was 70.5% (62/88) in the indomethacin group and 61.5% (32/52) in the ibuprofen group (p = 0.342). The incidence rates of oliguria and elevated serum creatinine were significantly lower in the ibuprofen group (p =0.002 and p =0.022, respectively). There was no significant difference in incidence of upper gastrointestinal hemorrhage or necrotizing enterocolitis between the ibuprofen and indomethacin groups (17.3% versus 23.9%; 3.8% versus 11.3%). CONCLUSION In infants with VLBW, oral ibuprofen is as effective as intravenous indomethacin for closure of PDA and is associated with significantly fewer cases of necrotizing enterocolitis among infants with birth body weights <1250 g and significantly lower rates of elevated creatinine levels among neonates with birth body weights ranging from 1000 to 1500 g.
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Olukman O, Calkavur S, Ercan G, Atlihan F, Oner T, Tavli V, Kultursay N. Comparison of Oral and Intravenous Ibuprofen for Medical Closure of Patent Ductus Arteriosus: Which One Is Better? CONGENIT HEART DIS 2012; 7:534-43. [DOI: 10.1111/j.1747-0803.2012.00668.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meißner U, Chakrabarty R, Topf HG, Rascher W, Schroth M. Improved closure of patent ductus arteriosus with high doses of ibuprofen. Pediatr Cardiol 2012; 33:586-90. [PMID: 22307401 DOI: 10.1007/s00246-012-0182-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/17/2011] [Indexed: 11/26/2022]
Abstract
The patent ductus arteriosus (PDA) is associated with various complications of prematurity. Cyclooxygenase-inhibitors are the first-line intervention for closure of the PDA. However, the rates of PDA closure still are unsatisfactory. Therefore, an individual trial was performed by changing the strategy for treating neonates with ibuprofen to induce the closure of PDA. In a retrospective study, patients receiving 20, 10, and 10 mg/kg bodyweight ibuprofen (group 1) were compared by chart review with those receiving 10, 5, 5 mg/kg (group 2). The rate of PDA closure, the incidence of side effects related to the use of ibuprofen, and the need for surgical intervention for closure of the PDA were analyzed. A higher rate of closure after three doses in group 1 could be observed (60.9 vs 52.6%; p = 0.75), which was not significant but indicated a clear positive trend. If closure of the PDA was unsuccessful, intravenous ibuprofen was continued for an additional 2 days. After 5 days, 91.3% of PDA in group 1 was closed compared with 68.4% PDA in group 2. In summary, only 8.7% of the group 1 neonates needed surgical closure of PDA after insufficient medicamentous closure compared with 31.6% in group 2 (p = 0.25). Although not statistically significant, a clear positive trend for using the higher-dose medication can be seen. More work dealing with the limitations of a retrospective study must be done. Based on the data from this study, high-dose ibuprofen seems able to increase the rate of effective medicamentous PDA closure without any further unwanted side effects.
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Affiliation(s)
- Udo Meißner
- Department of Pediatrics, University of Erlangen-Nurnberg, Loschgestrasse 15, 91054 Erlangen, Germany
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Johnston PG, Gillam-Krakauer M, Fuller MP, Reese J. Evidence-based use of indomethacin and ibuprofen in the neonatal intensive care unit. Clin Perinatol 2012; 39:111-36. [PMID: 22341541 PMCID: PMC3598606 DOI: 10.1016/j.clp.2011.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Indomethacin and ibuprofen are potent inhibitors of prostaglandin synthesis. Neonates have been exposed to these compounds for more than 3 decades. Indomethacin is commonly used to prevent intraventricular hemorrhage (IVH), and both drugs are prescribed for the treatment or prevention of patent ductus arteriosus (PDA). This review examines the basis for indomethacin and ibuprofen use in the neonatal intensive care population. Despite the call for restrained use of each drug, the most immature infants are likely to need pharmacologic approaches to reduce high-grade IVH, avoid the need for PDA ligation, and preserve the opportunity for an optimal outcome.
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Affiliation(s)
- Palmer G. Johnston
- Neonatal-Perinatal Medicine, Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children’s Way, Doctor’s Office Tower 11111, Nashville, TN 37232-9544, USA
| | - Maria Gillam-Krakauer
- Neonatal-Perinatal Medicine, Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children’s Way, Doctor’s Office Tower 11111, Nashville, TN 37232-9544, USA
| | - M. Paige Fuller
- Department of Pharmacy, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s Way, Room 4508, Nashville, TN 37232, USA
| | - Jeff Reese
- Neonatal-Perinatal Medicine, Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children’s Way, Doctor’s Office Tower 11111, Nashville, TN 37232-9544, USA,Department of Cell and Developmental Biology, Vanderbilt University Medical Center, U-3218 MRB III Building, Nashville, TN 37232-8240, USA,Corresponding author. Department of Cell and Developmental Biology, Vanderbilt University Medical Center, U-3218 MRB III Building, Nashville, TN 37232-8240.,
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Disruption of the serotonergic system after neonatal hypoxia-ischemia in a rodent model. Neurol Res Int 2012; 2012:650382. [PMID: 22474587 PMCID: PMC3306961 DOI: 10.1155/2012/650382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/26/2011] [Accepted: 11/01/2011] [Indexed: 12/16/2022] Open
Abstract
Identifying which specific neuronal phenotypes are vulnerable to neonatal hypoxia-ischemia, where in the brain they are damaged, and the mechanisms that produce neuronal losses are critical to determine the anatomical substrates responsible for neurological impairments in hypoxic-ischemic brain-injured neonates. Here we describe our current work investigating how the serotonergic network in the brain is disrupted in a rodent model of preterm hypoxia-ischemia. One week after postnatal day 3 hypoxia-ischemia, losses of serotonergic raphé neurons, reductions in serotonin levels in the brain, and reduced serotonin transporter expression are evident. These changes can be prevented using two anti-inflammatory interventions; the postinsult administration of minocycline or ibuprofen. However, each drug has its own limitations and benefits for use in neonates to stem damage to the serotonergic network after hypoxia-ischemia. By understanding the fundamental mechanisms underpinning hypoxia-ischemia-induced serotonergic damage we will hopefully move closer to developing a successful clinical intervention to treat neonatal brain injury.
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Romagnoli C, Bersani I, Rubortone SA, Lacerenza S, De Carolis MP. Current evidence on the safety profile of NSAIDs for the treatment of PDA. J Matern Fetal Neonatal Med 2011; 24 Suppl 3:10-3. [PMID: 21749302 DOI: 10.3109/14767058.2011.604987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patent ductus arteriosus (PDA) complicates the clinical course of preterm infants. Nonsteroidal anti-inflammatory drugs, especially Indomethacin and Ibuprofen, have been widely used for both prevention and treatment of PDA. Short-term efficacy of Indomethacin or Ibuprofen is equivalent, while Ibuprofen results show a higher safety profile. Ibuprofen is associated with fewer clinical gastrointestinal and renal side effects with respect to Indomethacin even if subclinical potential effects are reported. When administered as prophylaxis, Ibuprofen has no effects on prevention of intraventricular haemorrhage unlike Indomethacin. Considering the potential adverse effects of both these drugs, a careful monitoring during and after the treatment period is highly recommended.
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Affiliation(s)
- Costantino Romagnoli
- Department of Paediatrics and Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy.
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Fanos V, Marcialis MA, Bassareo PP, Antonucci R, Zaffanello M, Dessì A, Iacovidou N. Renal safety of Non Steroidal Anti Inflammatory Drugs (NSAIDs) in the pharmacologic treatment of patent ductus arteriosus. J Matern Fetal Neonatal Med 2011; 24 Suppl 1:50-2. [DOI: 10.3109/14767058.2011.607593] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rao R, Bryowsky K, Mao J, Bunton D, McPherson C, Mathur A. Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus. J Perinatol 2011; 31:465-70. [PMID: 21252965 DOI: 10.1038/jp.2010.199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To review intestinal complications associated with ibuprofen treatment of patent ductus arteriosus (PDA). STUDY DESIGN Data from preterm infants treated with ibuprofen were retrospectively reviewed. χ(2) test and Fischer's exact test were used for univariate analyses. Multivariate analyses with logistic regression modeling were used to identify risk factors. RESULT One hundred and two infants were treated with ibuprofen for PDA. Nine (9/102, 8.8%) infants developed spontaneous intestinal perforation (SIP), whereas 93/102 (91.2%) did not. The mean (± s.d.) gestational age (GA) at birth in infants with and without SIP was 25.2 (± 1.3) vs 27.6 (± 2.4) weeks (P=0.02) and the median (interquartile) length of stay (LOS) was 109.5 (91.0 to 116.5) vs 75.0 (53.0 to 94.5) days (P=0.002), respectively. The mean (± s.d.) age at starting ibuprofen was 3.3 (± 1.3) vs 5.8 (± 3.5) days in infants with and without SIP, respectively (P=0.03). In logistic regression analyses, increasing GA and later initiation of ibuprofen treatment were protective against risk of SIP; odds ratio, 95% confidence interval (OR, 95% CI)=0.26 (0.09 to 0.75), P=0.01 and 0.63 (0.41 to 0.95), P=0.03, respectively. CONCLUSION Infants at lower GA are at risk of SIP when treated early with ibuprofen for symptomatic PDA.
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Affiliation(s)
- R Rao
- Division of Newborn Medicine, Washington University in St Louis, St Louis, MO 63110, USA.
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Ibuprofen inhibits neuroinflammation and attenuates white matter damage following hypoxia-ischemia in the immature rodent brain. Brain Res 2011; 1402:9-19. [PMID: 21696706 DOI: 10.1016/j.brainres.2011.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/16/2011] [Accepted: 06/01/2011] [Indexed: 11/24/2022]
Abstract
Damage to major white matter tracts is a hallmark mark feature of hypoxic-ischemic (HI) brain injury in the preterm neonate. There is, however, no therapeutic intervention to treat this injury. Neuroinflammation is thought to play a prominent role in the pathogenesis of the HI-induced white matter damage but identification of the key mediators that constitute the inflammatory response remain to be fully elucidated. Cyclooxygenase enzymes (COX-1 and COX-2) are candidate neuroinflammatory mediators that may contribute to the HI-induced demise of early oligodendrocyte progenitors and myelination. We investigated whether ibuprofen, a non-steroidal anti-inflammatory drug that inhibits COX enzymes, can attenuate neuroinflammation and associated white matter damage incurred in a rodent model of preterm HI. On postnatal day 3 (P3), HI was produced (right carotid artery ligation and 30 min 6% O(2)). An initial dose of ibuprofen (100mg/kg, s.c.) was administered 2h after HI followed by a maintenance dose (50mg/kg, s.c.) every 24h for 6 days. Post-HI ibuprofen treatment significantly attenuated the P3 HI-induced increases in COX-2 protein expression as well as interleukin-1beta (IL-1β) and tumour necrosis factor-alpha (TNF-α) levels in the brain. Ibuprofen treatment also prevented the HI-induced loss O4- and O1-positive oligodendrocyte progenitor cells and myelin basic protein (MBP)-positive myelin content one week after P3 HI. These findings suggest that a repeated, daily, ibuprofen treatment regimen administered after an HI insult may be a potential therapeutic intervention to prevent HI-induced damage to white matter progenitors and early myelination in the preterm neonate.
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Affiliation(s)
- David A Rosen
- Department of Anesthesia and Pediatrics, West Virginia University School of Medicine, WV, USA
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Abstract
AIM To evaluate the effect of ibuprofen on bilirubin-albumin binding affinity and unbound bilirubin in premature infants. STUDY DESIGN A prospective study with subjects serving as their own controls was performed on <30 weeks' gestational age infants with unconjugated hyperbilirubinemia and who received ibuprofen for patent ductus arteriosus. Infants with congenital malformation, TORCH infections, and conjugated hyperbilirubinemia were excluded. Total serum bilirubin (TSB) and unbound bilirubin (modified peroxidase test) were measured prior to (baseline) and after (follow-up) initiation of ibuprofen. The bilirubin/albumin equilibrium association binding constant was calculated using albumin, TSB, and unbound bilirubin. RESULTS Ten infants were studied. The mean TSB between baseline (5.9±1.7 mg/dL) was higher than that at follow-up [4.9±1.7 mg/dL]. Mean unbound bilirubin at baseline (0.75±0.65 μg/dL) was similar to that at follow-up (0.63±0.46 μg/dL). No difference existed between mean baseline binding constant (49±50 L/μmol) and that at follow-up (44±36 L/μmol). The ratio of unbound bilirubin with and without ibuprofen, index of displacing effect, was 0.88 (95% CI 0.63-1.14). CONCLUSIONS Ibuprofen may not be associated with bilirubin displacing effect in relatively stable premature infants with mild to moderate unconjugated hyperbilirubinemia.
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Affiliation(s)
- Sanjiv B. Amin
- Corresponding author: Sanjiv B. Amin, MD, MS, Department of Pediatrics, PO Box 651, 601 Elmwood Avenue, Rochester, NY 14642, USA, Tel.: +1 585-275-2972, Fax: +1 585-461-3614,
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Flisberg A, Kjellmer I, Löfhede J, Löfgren N, Rosa-Zurera M, Lindecrantz K, Thordstein M. Does indomethacin for closure of patent ductus arteriosus affect cerebral function? Acta Paediatr 2010; 99:1493-7. [PMID: 20456268 DOI: 10.1111/j.1651-2227.2010.01857.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study whether indomethacin used in conventional dose for closure of patent ductus arteriosus affects cerebral function measured by electroencephalograms (EEG) evaluated by quantitative measures. STUDY DESIGN Seven premature neonates with haemodynamically significant persistent ductus arteriosus were recruited. EEG were recorded before, during and after an intravenous infusion of 0.2 mg/kg indomethacin over 10 min. The EEG was analysed by two methods with different degrees of complexity for the amount of low-activity periods (LAP, "suppressions") as an indicator of affection of cerebral function. RESULTS Neither of the two methods identified any change in the amount of LAPs in the EEG as compared to before the indomethacin infusion. CONCLUSION Indomethacin in conventional dose for closure of patent ductus arteriosus does not affect cerebral function as evaluated by quantitative EEG.
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Affiliation(s)
- A Flisberg
- Department of Pediatrics, The Queen Silvia Children's Hospital Sahlgrenska University Hospital-Östra, Göteborg, Sweden.
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Katakam LI, Cotten CM, Goldberg RN, Dang CN, Smith PB. Safety and effectiveness of indomethacin versus ibuprofen for treatment of patent ductus arteriosus. Am J Perinatol 2010; 27:425-9. [PMID: 20013605 PMCID: PMC2877168 DOI: 10.1055/s-0029-1243371] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We compared the rates of medical closure of patent ductus arteriosus (PDA) and complications (renal dysfunction, necrotizing enterocolitis, spontaneous intestinal perforation, and intraventricular hemorrhage) between infants treated with indomethacin and infants treated with ibuprofen. We performed a retrospective comparative cohort study of infants treated with indomethacin or ibuprofen for symptomatic PDA at Duke University Medical Center between November 2005 and November 2007. We identified 65 infants who received indomethacin and 57 who received ibuprofen. The rate of survival without surgical ductal ligation was 62% (40/65) in the indomethacin group and 58% (33/57) in the ibuprofen group (p = 0.71). The rate of the composite of complications (death, necrotizing enterocolitis, or intestinal perforation) was 40% (26/65) in the indomethacin group and 32% (18/57) in the ibuprofen group (p = 0.35). There was no significant difference between groups in elevation of serum creatinine during treatment. In clinical practice, ibuprofen appears to be as effective as indomethacin for closure of patent ductus arteriosus with similar complication rates. The decision to use one agent over the other should be based on dose schedule preference and the currently published clinical trials until more safety and effectiveness data are available.
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Affiliation(s)
- Lakshmi I Katakam
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - C Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - Ronald N Goldberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - Chi N Dang
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States, Duke Clinical Research Institute, Durham, North Carolina, United States
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Rheinlaender C, Helfenstein D, Pees C, Walch E, Czernik C, Obladen M, Koehne P. Neurodevelopmental outcome after COX inhibitor treatment for patent ductus arteriosus. Early Hum Dev 2010; 86:87-92. [PMID: 20153127 DOI: 10.1016/j.earlhumdev.2009.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 12/11/2009] [Accepted: 12/30/2009] [Indexed: 11/17/2022]
Abstract
AIM To compare neurodevelopmental results in very low birth weight (VLBW) infants two years after successful or failed cyclooxygenase inhibitor treatment with either indomethacin or ibuprofen for a haemodynamically significant patent ductus arteriosus (hsPDA). METHODS We retrospectively evaluated closure rates and outcome parameters of VLBW infants with hsPDA 89 of whom were treated with indomethacin and 93 with ibuprofen. RESULTS Indomethacin and ibuprofen therapy groups did not differ in their baseline clinical profile (median gestational age 26.0 and 26.2wksd) in early (median CRIB 6 and 5, respiratory distress >2 degrees in 36 and 34 infants) and late morbidities (intraventricular hemorrhage >2 degrees in 9 and 10 infants, bronchopulmonary dysplasia in 31 and 27 infants, 80 and 85 survivors), PDA closure rates (63 and 58%) or neurodevelopmental outcome. The therapy failure group (54 infants) was characterized by lower median gestational age (25.0wksd) and higher mortality (17%). No differences were found in the neurodevelopmental outcome of the surviving infants with ligation as compared to the survivors with successful pharmacological closure of the PDA at 24months corrected age. CONCLUSION Use of either ibuprofen or indomethacin for closure of a hsPDA did not influence two year neurodevelopmental outcomes in VLBW infants.
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Affiliation(s)
- C Rheinlaender
- Department of Neonatology, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Germany
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Quantitation of ibuprofen in blood using gas chromatography-mass spectrometry (GC-MS). Methods Mol Biol 2010; 603:289-96. [PMID: 20077080 DOI: 10.1007/978-1-60761-459-3_27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ibuprofen is a non-narcotic, non-steroidal anti-inflammatory drug used for the treatment of pain, fever, and inflammatory diseases such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. It is also used for induction of closure of patent ductus arteriosus (PDA) in neonates. Although the exact mechanism of action of ibuprofen is not known, it is believed to mediate its therapeutic effects through the inhibition of cyclooxygenase and subsequently by the inhibition of prostacyclin production. As the drug has a number of side effects, which correlate to its circulating concentration, monitoring of ibuprofen in plasma or serum is desired for patients receiving high-dose therapy. Chromatographic methods are frequently used for the assay of ibuprofen, as no immunoassays are currently available.In the method described, the drug is extracted from the serum or plasma using methylene chloride and phosphate buffer (pH 6). Meclofenamic acid is used as an internal standard. The organic phase containing the drug is separated and dried under stream of nitrogen. After trimethylsilyl derivatization, analysis is done using gas-chromatography/ mass spectrometry (GC-MS). Quantification of the drug in a sample is achieved by comparing responses of the unknown sample to the responses of the calibrators using selected ion monitoring.
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Sheikh Hassan A, Sapin A, Lamprecht A, Emond E, El Ghazouani F, Maincent P. Composite microparticles with in vivo reduction of the burst release effect. Eur J Pharm Biopharm 2009; 73:337-44. [DOI: 10.1016/j.ejpb.2009.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/16/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
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Fanos V, Guimarâes H. Present and future of European neonatologyFocus on Patent Ductus Arteriosus. J Matern Fetal Neonatal Med 2009; 22 Suppl 3:1-2. [DOI: 10.1080/14767050903199304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Richards J, Johnson A, Fox G, Campbell M. A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants. Pediatrics 2009; 124:e287-93. [PMID: 19651568 DOI: 10.1542/peds.2008-2232] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There are few published data on the efficacy of ibuprofen in the most immature infants and no data on repeated courses. Our objectives were to describe PDA closure rates in a population of infants <1000 g birth weight after repeated courses of ibuprofen, to examine the effect of gestation, and to document plasma markers of renal function and platelet counts. METHODS This was a single center observational study. We collected data on infants weighing <1000 g at birth who were treated with ibuprofen for a clinically significant PDA. A successful outcome was defined as resolution of clinical symptoms such that no additional treatment was required. Serum biochemistry and hematology data were analyzed and compared with controls. RESULTS We identified 160 infants with a mean +/- SD birth weight of 757 +/- 127 g and gestation of 25.6 +/- 1.4 weeks. Seventy infants closed their PDA after a single course of ibuprofen (45%) and 32/80 (40%) following a second. Infants of <26 weeks' gestation (n = 83) were less likely to respond after both the first (27.7% vs 63.6%; P < .001) and second (30.9% vs 60.0%; P = .026) courses. The postnatal decrease in plasma creatinine was delayed by ibuprofen treatment, while platelet counts and other plasma markers were unaffected. CONCLUSIONS In our study population, PDA closure was gestation dependant, with a cumulative closure rate of 65%. A similar proportion of infants closed their PDA following the first and second courses regardless of gestation. These data suggest that a second course of ibuprofen may be effective in closing a PDA in even the most preterm infant.
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Affiliation(s)
- Justin Richards
- Neonatal Intensive Care Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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Derry CJ, Derry S, Moore RA, McQuay HJ. Single dose oral ibuprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; 2009:CD001548. [PMID: 19588326 PMCID: PMC4171980 DOI: 10.1002/14651858.cd001548.pub2] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND This review updates a 1999 Cochrane review showing that ibuprofen at various doses was effective in postoperative pain in single dose studies designed to demonstrate analgesic efficacy. New studies have since been published. Ibuprofen is one of the most widely used non-steroidal anti-inflammatory (NSAID) analgesics both by prescription and as an over-the-counter medicine. Ibuprofen is used for acute and chronic painful conditions. OBJECTIVES To assess analgesic efficacy of ibuprofen in single oral doses for moderate and severe postoperative pain in adults. SEARCH STRATEGY We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to May 2009. SELECTION CRITERIA Randomised, double blind, placebo-controlled trials of single dose orally administered ibuprofen (any formulation) in adults with moderate to severe acute postoperative pain. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. MAIN RESULTS Seventy-two studies compared ibuprofen and placebo (9186 participants). Studies were predominantly of high reporting quality, and the bulk of the information concerned ibuprofen 200 mg and 400 mg. For at least 50% pain relief compared with placebo the NNT for ibuprofen 200 mg (2690 participants) was 2.7 (2.5 to 3.0) and for ibuprofen 400 mg (6475 participants) it was 2.5 (2.4 to 2.6). The proportion with at least 50% pain relief was 46% with 200 mg and 54% with 400 mg. Remedication within 6 hours was less frequent with higher doses, with 48% remedicating with 200 mg and 42% with 400 mg. The median time to remedication was 4.7 hours with 200 mg and 5.4 hours with 400 mg. Sensitivity analysis indicated that pain model and ibuprofen formulation may both affect the result, with dental impaction models and soluble ibuprofen salts producing better efficacy estimates. Adverse events were uncommon, and not different from placebo. AUTHORS' CONCLUSIONS The very substantial amount of high quality evidence demonstrates that ibuprofen is an effective analgesic in treating postoperative pain. NNTs for 200 mg and 400 mg ibuprofen did not change significantly from the previous review even when a substantial amount of new information was added. New information is provided on remedication.
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Affiliation(s)
- Christopher J Derry
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordOxfordshireUKOX3 7LE
| | | | | | - Henry J McQuay
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordOxfordshireUKOX3 7LE
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Bhandari V, Zhou G, Bizzarro MJ, Buhimschi C, Hussain N, Gruen JR, Zhang H. Genetic contribution to patent ductus arteriosus in the premature newborn. Pediatrics 2009; 123:669-73. [PMID: 19171636 PMCID: PMC3161726 DOI: 10.1542/peds.2008-1117] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The most common congenital heart disease in the newborn population, patent ductus arteriosus, accounts for significant morbidity in preterm newborns. In addition to prematurity and environmental factors, we hypothesized that genetic factors play a significant role in this condition. OBJECTIVE The objective of this study was to quantify the contribution of genetic factors to the variance in liability for patent ductus arteriosus in premature newborns. PATIENTS AND METHODS A retrospective study (1991-2006) from 2 centers was performed by using zygosity data from premature twins born at < or =36 weeks' gestational age and surviving beyond 36 weeks' postmenstrual age. Patent ductus arteriosus was diagnosed by echocardiography at each center. Mixed-effects logistic regression was used to assess the effect of specific covariates. Latent variable probit modeling was then performed to estimate the heritability of patent ductus arteriosus, and mixed-effects probit modeling was used to quantify the genetic component. RESULTS We obtained data from 333 dizygotic twin pairs and 99 monozygotic twin pairs from 2 centers (Yale University and University of Connecticut). Data on chorioamnionitis, antenatal steroids, gestational age, body weight, gender, respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, oxygen supplementation, and bronchopulmonary dysplasia were comparable between monozygotic and dizygotic twins. We found that gestational age, respiratory distress syndrome, and institution were significant covariates for patent ductus arteriosus. After controlling for specific covariates, genetic factors or the shared environment accounted for 76.1% of the variance in liability for patent ductus arteriosus. CONCLUSIONS Preterm patent ductus arteriosus is highly familial (contributed to by genetic and environmental factors), with the effect being mainly environmental, after controlling for known confounders.
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Affiliation(s)
- Vineet Bhandari
- Yale University School of Medicine, Department of Pediatrics, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064, USA.
| | - Gongfu Zhou
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew J. Bizzarro
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Catalin Buhimschi
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | - Naveed Hussain
- Division of Neonatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Jeffrey R. Gruen
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut,Department of Genetics, Yale University School of Medicine, New Haven, Connecticut,Department of Investigative Medicine, Yale University School of Medicine, New Haven, Connecticut,Department of Yale Child Health Research Center, Yale University School of Medicine, New Haven, Connecticut
| | - Heping Zhang
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
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Sheffield MJ, Schmutz N, Lambert DK, Henry E, Christensen RD. Ibuprofen lysine administration to neonates with a patent ductus arteriosus: effect on platelet plug formation assessed by in vivo and in vitro measurements. J Perinatol 2009; 29:39-43. [PMID: 18754013 DOI: 10.1038/jp.2008.122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Ibuprofen might have advantages over indomethacin, when used to effectuate closure of a neonate's patent ductus arteriosus (PDA). Several previous studies indicate that platelet plug formation is impaired after administration of indomethacin, but it is not clear whether a similar impairment occurs following ibuprofen dosing. STUDY DESIGN We performed template bleeding times and PFA-100 tests (platelet function analyzer) on 20 neonates who had a PDA, before and again at various preset intervals following ibuprofen dosing. RESULT Patients ranged from 23 to 40 weeks gestation and weighed 511 to 2566 g. Their first dose of ibuprofen was administered at 72 h (18 to 363 h) after birth (median, range). None of the subjects had clinical bleeding problems noted during the days they received ibuprofen dosing. The template bleeding times before dosing ranged from 135 to 450 s. Repeat tests were performed in groups of four, at 2 h, 4 to 6 h, 12 to 18 h, 24 h after the first dose, and at 2 h after the third dose of ibuprofen. No changes in bleeding times were detected. (P=0.299) A PFA-100 time was performed on all 20 patients before and again after the ibuprofen administration. However, 3 of the 40 tests were unsuccessful, because of microclots in the blood sample (n=1) or failure of the analyzer for an unspecified reason (n=2). Before the dosing the PFA-100 time ranged from 52 to 300 s. A paired t-test showed a slight but statistically significant lengthening in PFA-100 time after the ibuprofen administration (P=0.019). The correlation between the bleeding time and the PFA-100 was poor (R(2)=0.212, P=0.576). CONCLUSION On the basis of our present studies, we speculate that ibuprofen lysine administration to neonates with a PDA, when used according to the manufacturer's recommendations, has little adverse effect on platelet plug formation. This information might be a factor to consider when deciding whether to select indomethacin or ibuprofen for PDA closure.
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Affiliation(s)
- M J Sheffield
- Intermountain Healthcare, McKay-Dee Hospital Center, Ogden, UT, USA.
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Rheinlaender C, Helfenstein D, Walch E, Berns M, Obladen M, Koehne P. Total serum bilirubin levels during cyclooxygenase inhibitor treatment for patent ductus arteriosus in preterm infants. Acta Paediatr 2009; 98:36-42. [PMID: 18764861 DOI: 10.1111/j.1651-2227.2008.01007.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine whether ibuprofen use in VLBW infants is associated with increased serum bilirubin levels and impaired neurodevelopmental outcome at 2 years of age compared to indomethacin. METHODS We retrospectively evaluated bilirubin data and outcome parameters of 178 VLBW infants treated with COX inhibitors for a haemodynamically relevant patent ductus arteriosus (PDA) between 1998 and 2003 in a single institution. In our department ibuprofen replaced indomethacin for PDA treatment in 2001, while clinical and echocardiographic criteria for the indication of PDA invention have remained unchanged. RESULTS Ibuprofen and indomethacin therapy groups did not differ in their baseline clinical profile. Peak serum bilirubin concentration was 10.2 mg/dL in the ibuprofen group and 8.6 mg/dL in the indomethacin group (p < 0.01), while phototherapy duration did not differ. At 2 years of age neurodevelopmental outcome was similar in both groups. In a single case analysis, four cases of adverse neurodevelopmental outcome despite inconspicuous clinical course were identified in the ibuprofen group. CONCLUSION In VLBW infants with PDA, ibuprofen treatment was associated with higher bilirubin levels than indomethacin.
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Affiliation(s)
- C Rheinlaender
- Department of Neonatology, Charité, Campus Virchow Hospital, University Medicine Berlin, Augustenberger Platz 1, Berlin, Germany
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Aranda JV, Beharry KD, Valencia GB. Nonsteroidal anti-inflammatory drugs (NSAIDs) in the newborn – which ones? J Matern Fetal Neonatal Med 2009; 22 Suppl 3:21-2. [DOI: 10.1080/14767050903194461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McCrea HJ, Ment LR. The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol 2008; 35:777-92, vii. [PMID: 19026340 PMCID: PMC2901530 DOI: 10.1016/j.clp.2008.07.014] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intraventricular hemorrhage (IVH) occurs in 20% to 25% of very low birthweight preterm neonates and may be associated with significant sequelae. Infants who have IVH are at risk for posthemorrhagic hydrocephalus and periventricular leukomalacia; as many as 75% of those who have parenchymal involvement of hemorrhage suffer significant neurodevelopmental disability. Because of the prevalence of IVH and the medical and societal impact of this disease, many postnatal pharmacologic prevention strategies have been explored. Randomized clinical prevention trials should provide long-term neurodevelopmental follow-up to assess the impact of preterm birth, injury, and pharmacologic intervention on the developing brain.
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Affiliation(s)
| | - Laura R. Ment
- Departments of Pediatrics and Neurology, and Associate Dean for Admissions, Yale University School of Medicine, New Haven, CT
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Golombek S, Sola A, Baquero H, Borbonet D, Cabañas F, Fajardo C, Goldsmit G, Lemus L, Miura E, Pellicer A, Pérez J, Rogido M, Zambosco G, van Overmeire B. Primer consenso clínico de SIBEN: enfoque diagnóstico y terapéutico del ductus arterioso permeable en recién nacidos pretérmino. An Pediatr (Barc) 2008. [DOI: 10.1157/13128002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hassan AS, Sapin A, Ubrich N, Maincent P, Bolzan C, Leroy P. Simple and Sensitive HPLC Method with Fluorescence Detection for the Measurement of Ibuprofen in Rat Plasma: Application to a Long-Lasting Dosage Form. Drug Dev Ind Pharm 2008; 34:1064-70. [DOI: 10.1080/03639040801950188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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