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Study of efficacy of oral ibuprofen in preterm neonates with PDA and impact on short term clinical variables
S154
Abstracts
Background and aim Congenital complete heart block (CHB) is as conduction defect with an incidence in the general population of 1/15,000 to 1/22,000 life-born infants. It is frequently associated with structural heart defects and autoimmune maternal disease. It can be divided in 2 groups: associated with maternal connective tissue disease — representing 90% to 99% of the CHB cases diagnosed in the first 6 months of life; and those of unknown aetiology, which occur in the absence of autoimmune maternal disease, detected later in life and with better prognosis. Materials and methods A retrospective evaluation of the medical records of all cases of CHB diagnosed at our institution, since January 1994, was performed. Maternal anti-antibody status was detailed, establishing Group A (positive maternal autoimmune status) and group B (no maternal auto-antibodies). Besides that, pre and postnatal variables (ventricular rate — VR; need, age and indicators for pacing) were documented. Results Fourteen cases of CHB were detected, between 17 to 36 weeks of gestation. Three died in the prenatal period (2 with severe associated structural heart defects — right isomerism, complete AV canal; and one with hydrops fetalis). Among the 11 survivors, one presented congenitaly corrected transposition of the great arteries. The remaining 10 cases represented isolated CHB (ICHB). In group A there were 5 patients (50% of ICHB) and pacemaker was needed in 2: one at day 9 of life (VR < 50 bpm) and the other at 11 years old. In group B (5 cases), 3 cases had a birth VR < 50 bpm, requiring pacemaker implantation at 1st, 3rd and 210th day of life, respectively. In those who had a birth VR > 50 bpm, only one came to implant a pacemaker at 5 years old, due to pauses > 3 s. Corticotherapy was performed only in one of all patients. No sympathomimetics were used. Until this date, dilated cardiomiopathy (DCM) was not diagnosed in this group of children.
our centre. Oral Ibuprofen was administered (a first dose of 10 mg per kilogram, followed at 24-hour intervals by five doses of 5 mg per kilogram day), as soon as significant duct was detected by Echocardiography. A ductal diameter >1.4 mm/kg body weight and LA/AO ratio >1.3 were taken as significant ducts. Rate of ductal closure, side effects, complications, and the infant's clinical course were recorded. Exclusion criteria were major congenital anomalies; recent Intraventricular hemorrhage (within the previous 24 h); urine output below 1 mL per kilogram of body weight per hour during the preceding 8 h; a serum creatinine concentration of 1.6 mg per decilitre (140 μmol per liter) or higher; a serum urea nitrogen concentration greater than 40 mg per decilitre (14 mmol per liter); a platelet count of 60,000 per cubic millimetre or less; a tendency to bleed, blood in the endotracheal aspirate, gastric aspirate, or stools, and oozing from puncture sites and hyperbilirubinemia necessitating exchange transfusion. Results The rate of PDA closure was 85% (68 of 80). Rest were treated with either repeat course of oral Ibuprofen 4(5%) or IV Indomethacin 6 (7.5%) or surgical ligation 2 (2.5%). There was no ductal reopening. Eleven (13.8%) of 80 babies developed BPD (no difference between closed PDA and PDA not closed group), oliguria developed in 5(6.3%) babies treated with oral Ibuprofen. Blood urea and serum creatinine were elevated in 3(3.8%). Bleeding tendency was seen among 34(42.5%). Grade II and above intraventricular bleeding was seen among 15 (18.75%) of the 80 newborns. Necrotising enterocolitis was seen among 14(17.5%).Feed intolerance was seen among 48 (60%). Conclusions Oral Ibuprofen is effective, safe, cheap and well tolerated with minimal side effects. We recommend multi centre RCTs to show the expected beneficial results in a larger population of preterm neonates with significant PDA. doi:10.1016/j.earlhumdev.2008.09.400
Conclusions The CHB diagnosed in utero is related to a significant morbimortality. Hydrops fetalis, structural cardiopathy and low fetal/neonatal VR are bad prognosis factors. Some reports describe earlier pacing and more severe prognosis among patients with maternal autoimmune disease, however, in our group it didn't occur. None of our patients developed DMC. Regular, careful monitoring during pregnancy is required in order to optimise care and timing of any interventions. doi:10.1016/j.earlhumdev.2008.09.399
Abstract UENPS.384 Study of efficacy of oral ibuprofen in preterm neonates with PDA and impact on short term clinical variables Sharma Manjunath⁎, Maralakunte Hariram⁎ Sagar Apollo Hospital, Bangalore, India Background and aim IV Indomethacin is the conventional treatment for patent ductus arteriosus in preterm infants. However, its use is associated with various side effects. A prospective study was done using oral Ibuprofen to know the efficacy and short term side effects. Materials and methods Study was conducted from July 2002–April 2008 in the Neonatal ICU. Eighty infants (gestational age < 32 weeks, wt 500–2000 g) who had an echocardiographically confirmed patent ductus arteriosus were studied in
Abstract UENPS.385 “Early curative” ibuprofen in the patent ductus arteriosus of the preterms ventilated infants Enrico Rosati⁎,a, Giuseppe Pomèb, Anna Cazzanigab, Giuseppe Latinic Perinatal Cardiology Unit, Perrino Hospital, Brindisi, Italy b Cardiac Surgery Department, San Donato Hospital, Milan, Italy c Neonatology Division, Perrino Hospital, Brindisi, Italy
a
Background and aim Patent ductus arteriosus (PDA) with a significant left-to-right shunting is a common problem in very premature infants with distress respiratory syndrome (RDS) increasing their risks of death or developing sequelae as CLD, ICH and NEC. Prophylactic use of cyclo-oxygenase inhibitors (Ibuprofen or Indomethacin) reduces the incidence of symptomatic PDA and the need of surgical ligation but it exposes a large proportion of infants unnecessarily to drugs that have important side effects. The aims of the present study were to evaluate: the effectiveness of “early curative” ibuprofen (ECI) in the closure of PDA in ventilated preterm infants the need of surgical ligation in this high-risk population the long-term follow up of the patients with residual PDA at discharge. Materials and methods We enrolled 206 neonates with postmenstrual age (PMA) < 30 weeks with RDS needing mechanical ventilation for more than 24 h. 137 of these were treated with intravenously ECI at a median age of 20.9 < 8.9 h of life (range 12–41). Indication to treatment was Doppler echocardiographic detection of ductal flow pattern predictive of developing symptomatic PDA (pattern “growing” or “pulsatile”).
Abstracts
Background and aim Congenital complete heart block (CHB) is as conduction defect with an incidence in the general population of 1/15,000 to 1/22,000 life-born infants. It is frequently associated with structural heart defects and autoimmune maternal disease. It can be divided in 2 groups: associated with maternal connective tissue disease — representing 90% to 99% of the CHB cases diagnosed in the first 6 months of life; and those of unknown aetiology, which occur in the absence of autoimmune maternal disease, detected later in life and with better prognosis. Materials and methods A retrospective evaluation of the medical records of all cases of CHB diagnosed at our institution, since January 1994, was performed. Maternal anti-antibody status was detailed, establishing Group A (positive maternal autoimmune status) and group B (no maternal auto-antibodies). Besides that, pre and postnatal variables (ventricular rate — VR; need, age and indicators for pacing) were documented. Results Fourteen cases of CHB were detected, between 17 to 36 weeks of gestation. Three died in the prenatal period (2 with severe associated structural heart defects — right isomerism, complete AV canal; and one with hydrops fetalis). Among the 11 survivors, one presented congenitaly corrected transposition of the great arteries. The remaining 10 cases represented isolated CHB (ICHB). In group A there were 5 patients (50% of ICHB) and pacemaker was needed in 2: one at day 9 of life (VR < 50 bpm) and the other at 11 years old. In group B (5 cases), 3 cases had a birth VR < 50 bpm, requiring pacemaker implantation at 1st, 3rd and 210th day of life, respectively. In those who had a birth VR > 50 bpm, only one came to implant a pacemaker at 5 years old, due to pauses > 3 s. Corticotherapy was performed only in one of all patients. No sympathomimetics were used. Until this date, dilated cardiomiopathy (DCM) was not diagnosed in this group of children.
our centre. Oral Ibuprofen was administered (a first dose of 10 mg per kilogram, followed at 24-hour intervals by five doses of 5 mg per kilogram day), as soon as significant duct was detected by Echocardiography. A ductal diameter >1.4 mm/kg body weight and LA/AO ratio >1.3 were taken as significant ducts. Rate of ductal closure, side effects, complications, and the infant's clinical course were recorded. Exclusion criteria were major congenital anomalies; recent Intraventricular hemorrhage (within the previous 24 h); urine output below 1 mL per kilogram of body weight per hour during the preceding 8 h; a serum creatinine concentration of 1.6 mg per decilitre (140 μmol per liter) or higher; a serum urea nitrogen concentration greater than 40 mg per decilitre (14 mmol per liter); a platelet count of 60,000 per cubic millimetre or less; a tendency to bleed, blood in the endotracheal aspirate, gastric aspirate, or stools, and oozing from puncture sites and hyperbilirubinemia necessitating exchange transfusion. Results The rate of PDA closure was 85% (68 of 80). Rest were treated with either repeat course of oral Ibuprofen 4(5%) or IV Indomethacin 6 (7.5%) or surgical ligation 2 (2.5%). There was no ductal reopening. Eleven (13.8%) of 80 babies developed BPD (no difference between closed PDA and PDA not closed group), oliguria developed in 5(6.3%) babies treated with oral Ibuprofen. Blood urea and serum creatinine were elevated in 3(3.8%). Bleeding tendency was seen among 34(42.5%). Grade II and above intraventricular bleeding was seen among 15 (18.75%) of the 80 newborns. Necrotising enterocolitis was seen among 14(17.5%).Feed intolerance was seen among 48 (60%). Conclusions Oral Ibuprofen is effective, safe, cheap and well tolerated with minimal side effects. We recommend multi centre RCTs to show the expected beneficial results in a larger population of preterm neonates with significant PDA. doi:10.1016/j.earlhumdev.2008.09.400
Conclusions The CHB diagnosed in utero is related to a significant morbimortality. Hydrops fetalis, structural cardiopathy and low fetal/neonatal VR are bad prognosis factors. Some reports describe earlier pacing and more severe prognosis among patients with maternal autoimmune disease, however, in our group it didn't occur. None of our patients developed DMC. Regular, careful monitoring during pregnancy is required in order to optimise care and timing of any interventions. doi:10.1016/j.earlhumdev.2008.09.399
Abstract UENPS.384 Study of efficacy of oral ibuprofen in preterm neonates with PDA and impact on short term clinical variables Sharma Manjunath⁎, Maralakunte Hariram⁎ Sagar Apollo Hospital, Bangalore, India Background and aim IV Indomethacin is the conventional treatment for patent ductus arteriosus in preterm infants. However, its use is associated with various side effects. A prospective study was done using oral Ibuprofen to know the efficacy and short term side effects. Materials and methods Study was conducted from July 2002–April 2008 in the Neonatal ICU. Eighty infants (gestational age < 32 weeks, wt 500–2000 g) who had an echocardiographically confirmed patent ductus arteriosus were studied in
Abstract UENPS.385 “Early curative” ibuprofen in the patent ductus arteriosus of the preterms ventilated infants Enrico Rosati⁎,a, Giuseppe Pomèb, Anna Cazzanigab, Giuseppe Latinic Perinatal Cardiology Unit, Perrino Hospital, Brindisi, Italy b Cardiac Surgery Department, San Donato Hospital, Milan, Italy c Neonatology Division, Perrino Hospital, Brindisi, Italy
a
Background and aim Patent ductus arteriosus (PDA) with a significant left-to-right shunting is a common problem in very premature infants with distress respiratory syndrome (RDS) increasing their risks of death or developing sequelae as CLD, ICH and NEC. Prophylactic use of cyclo-oxygenase inhibitors (Ibuprofen or Indomethacin) reduces the incidence of symptomatic PDA and the need of surgical ligation but it exposes a large proportion of infants unnecessarily to drugs that have important side effects. The aims of the present study were to evaluate: the effectiveness of “early curative” ibuprofen (ECI) in the closure of PDA in ventilated preterm infants the need of surgical ligation in this high-risk population the long-term follow up of the patients with residual PDA at discharge. Materials and methods We enrolled 206 neonates with postmenstrual age (PMA) < 30 weeks with RDS needing mechanical ventilation for more than 24 h. 137 of these were treated with intravenously ECI at a median age of 20.9 < 8.9 h of life (range 12–41). Indication to treatment was Doppler echocardiographic detection of ductal flow pattern predictive of developing symptomatic PDA (pattern “growing” or “pulsatile”).