Effect of ibuprofen on bilirubin-albumin binding during the treatment of patent ductus arteriosus in preterm infant

Pharmacotherapy for patent ductus arteriosus closure

Even though up to 60% of premature infants less than 28 weeks gestation develop persistent patent ductus arteriosus (PDA), there remains controversy regarding if, when, and how to close the PDA. Failure to close the PDA has been associated with significant morbidity but no cause-and-effect has been proven for short-term or long-term outcomes in modern times. Surgical closure has the advantage of eliminating the PDA, but short-term complications and long-term adverse outcomes are worrisome. Intravenous indomethacin has been the "gold standard" for pharmacologic treatment over the past 40 years with high closure rates and decreased incidence of severe intraventricular hemorrhage (IVH) and pulmonary hemorrhage with early treatment but without improvement in long-term outcomes and with risk of renal toxicity. Intravenous ibuprofen has less vasoconstrictive toxicity than indomethacin with comparable closure rates but without improvement in IVH and with hyperbilirubinemia risks. Earlier this decade, acetaminophen (paracetamol) was discovered to effectively close the PDA with good short-term safety profile. Although promising, acetaminophen treatment requires further studies regarding long-term safety as well as ideal dosing and route of administration.

Determination of ibuprofen enantiomers in human plasma by HPLC–MS/MS: validation and application in neonates

Aim: An adaptive method to determine ibuprofen enantiomers with limited volume of plasma required is necessary for investigating PK of ibuprofen in neonates. Results: Enantiomer separation was achieved on a Lux cellulose 3 column with mobile phase consisting of methanol water (85:15, v/v) and formic acid (0.0075%) at isocratic rate of 0.2 ml/min. Calibration curve is linear for each enantiomer at the range of 0.1–60 μg/ml. Validation was conducted and results met requirements regarding to intra- and inter-run precision, accuracy and recovery. No matrix effect or interference was observed from neonatal plasma or comedications. Only 20 μl of plasma was requested in this study. Conclusion: This assay was specific and reliable to quantify ibuprofen enantiomers in neonate plasma.

Patent ductus arteriosus in preterm infants: do we have the right answers?

Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs) to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS) PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.