solufenum and Infant--Premature--Diseases

Presence of symptomatic patent ductus arteriosus is common in small preterm infants and ibuprofen is commonly used for its medical closure. While efficacy is comparable to indomethacin, there are few case reports of severe hypoxemia and pulmonary hypertension following prophylactic ibuprofen administration. Cumulative dose effects and chemical composition may be important considerations. Possible mechanisms of occurrence of this complication in a preterm infant are discussed.

Topics: Cyclooxygenase Inhibitors; Ductus Arteriosus, Patent; Humans; Hypertension, Pulmonary; Ibuprofen; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Lysine

This retrospective, study compared the efficacy and safety of Ibuprofen-Lysinate (Arfen, intramuscular formulation, Group I, n=156) used during 2000-2005 and Sodium-ibuprofen (Pedea, intravenous solution, Group II, n=60) used during 2006-2008, for the prophylaxis of Patent Ductus Arteriosus in inborn neonates with gestational age ≤ 28 weeks. Ductus closure rate after prophylaxis was significantly higher (73.1% vs 50%; P=0.002) and surgical ligation significantly lower (8.2% vs 23.3%; P=0.005) in Group I. A smaller number of neonates of Group I vs Group II showed oliguria and hemorrhagic disease.

Topics: Cyclooxygenase Inhibitors; Ductus Arteriosus, Patent; Humans; Ibuprofen; Infant, Newborn; Infant, Premature, Diseases; Lysine; Retrospective Studies; Treatment Outcome

Persistently patent ductus arteriosus (PDA), affecting approximately one-third of all very low birth weight infants, can lead to significant morbidity and mortality. Recently, ibuprofen has been recommended over indomethacin to close PDAs because of a reduction in risk of necrotizing enterocolitis. Pulmonary hypertension is a rare but potentially fatal complication of ibuprofen administration in preterm infants. We report 2 infants who developed this complication after receiving therapeutic L-lysine ibuprofen preparation for the PDA closure. The first infant, 1 of twins weighing 640 g, was born at 24 weeks' gestation. The second infant, born at 26 weeks' gestation, was small for gestational age, weighing 439 g. In both cases, ibuprofen was initiated after echocardiographic confirmation of a moderate-sized to large PDA and an otherwise normal intracardiac anatomy. Both infants had echocardiographic evidence of increased pulmonary vascular resistance but shunting across the PDA was left to right. The infants deteriorated within 48 to 72 hours, and repeat echocardiograms revealed evidence of severe pulmonary hypertension. Both infants died of refractory hypotension and hypoxemia. When considering the use of ibuprofen therapy for PDA closure, clinicians should keep in mind the potential serious complication of pulmonary hypertension, even if a shunt across the PDA is left to right.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Diseases in Twins; Ductus Arteriosus, Patent; Echocardiography; Fatal Outcome; Humans; Hypertension, Pulmonary; Ibuprofen; Infant, Newborn; Infant, Premature, Diseases; Infant, Small for Gestational Age; Lysine; Male

To evaluate the effect of ibuprofen on bilirubin-albumin binding affinity and unbound bilirubin in premature infants.. 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.. 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).. Ibuprofen may not be associated with bilirubin displacing effect in relatively stable premature infants with mild to moderate unconjugated hyperbilirubinemia.

Topics: Albumins; Bilirubin; Cyclooxygenase Inhibitors; Ductus Arteriosus, Patent; Female; Humans; Hyperbilirubinemia; Ibuprofen; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lysine; Male; Prospective Studies