Skip to main content
SpringerLink
Log in

Controversies Around Treatment of the Open Duct

  • Chapter
Controversies around treatment of the open duct

  • 284 Accesses

Abstract

The optimal management of a patent ductus arteriosus (PDA) in the preterm infant is an ongoing debate which is fueled by changing clinical evidence, new insights in pathophysiology, and also influenced by the appearance of additional therapies in ante- and postnatal care during the last decade. Wide variability exists in the treatment approach of the PDA: e.g. the postnatal age at which the first dose of drug is given (prophylaxis, early or late treatment), the amount of fluids administered, which drug to use, additional courses or other adapted dosing schemes, and finally in last years the question arises more and more frequently whether any treatment at all is necessary in very low birth weight infants (VLBW). This chapter aims to address some of the current controversies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bell EF, Warburton D, Stonestreet BS, Oh W (1980) Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med 302: 598–604

    Article  PubMed  CAS  Google Scholar 

  2. Bell EF, Acarregui MJ (2008) Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 1: CD000503

    Google Scholar 

  3. Lorenz JM, Kleinman LI, Kotagal UR, Reller MD (1982) Water balance in very low-birthweight infants: relationship to water and sodium intake and effect on outcome. J Pediatr 101: 423–432

    Article  PubMed  CAS  Google Scholar 

  4. Tammela OK, Lanning FP, Koivisto ME (1992) The relationship of fluid restriction during the 1st month of life to the occurrence and severity of bronchopulmonary dysplasia in low birth weight infants: a 1-year radiological follow up. Eur J Pediatr 51: 295–299

    Article  Google Scholar 

  5. von Stockhausen HB, Struve M (1980) Effects of highly varying parenteral fluid intakes in premature and newborn infants during the first three days of life. Klin Padiatr 192: 539–546

    Article  Google Scholar 

  6. Kavvadia V, Greenough A, Dimitriou G, Hooper R, Kavvadia V, Greenough A, Dimitriou G, Hooper R (2000) Randomised trial of fluid restriction in ventilated very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 83: F91–96

    Article  PubMed  CAS  Google Scholar 

  7. Stephens BE, Gargus RA, Walden RV, Mance M, Nye J, McKinley L, Tucker R, Vohr BR (2008) Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 28: 123–128

    Article  PubMed  CAS  Google Scholar 

  8. Teixeira LS, Shivananda SP, Stephens D, von Arsdell G, McNamara PJ (2008) Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention. J Perinatol 28: 803–810

    Article  PubMed  CAS  Google Scholar 

  9. von Overmeire B, Brus F, van Acker K J, von Der Auwera J C, Schasfoort M, Elzenga N J, Okken A (1995) Aspirin versus indomethacin treatment of patent ductus arteriosus in preterm infants with respiratory distress syndrome. Pediatr Res 38: 886–891

    Article  PubMed  Google Scholar 

  10. Amato M, Hüppi P, Markus D (1993) Prevention of symptomatic patent ductus arteriosus with ethamsylate in babies treated with exogenous surfactant. J Perinatol 13: 2–7

    PubMed  CAS  Google Scholar 

  11. von Overmeire B, Follens I, Hartmann S, Creten WL, von Acker KJ (1997) Treatment of patent ductus arteriosus with ibuprofen. Arch Dis Child 76: F179–F184

    Google Scholar 

  12. Varvarigou A, Bardin CL, Beharry K, Chemtob S, Papageorgiou A, Aranda JV (1996) Early ibuprofen administration to prevent patent ductus arteriosus in premature newborn infants. JAMA 275: 539–544

    Article  PubMed  CAS  Google Scholar 

  13. Pezzati M, Vangi V, Biagiotti R et al. (1999) Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus. J Pediatr 135: 733–738

    Article  PubMed  CAS  Google Scholar 

  14. Patel J, Roberts I, Azzopardi D et al. (2000) Randomized double-blind controlled trial comparing the effects of ibuprofen with indomethacin on cerebral hemodynamics in preterm infants with patent ductus arteriosus. Pediatr Res 47: 36–42

    Article  PubMed  CAS  Google Scholar 

  15. von Overmeire B, Smets K, Lecoutere D, von de Broek H, Weyler J, De Groote K, Langhendries J-P (2000) A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med 343: 674–681

    Article  PubMed  Google Scholar 

  16. Mosca F, Bray M, Lattanzio M et al. (1997) Comparative evaluation of the effects of indomethacin and ibuprofen on cerebral perfusion and oxygenation in preterm infants with patent ductus arteriosus. J Pediatr 131: 549–554

    Article  PubMed  CAS  Google Scholar 

  17. Thomas RL, Parker GC, von Overmeire B, Aranda JV (2005) A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus. Eur J Pediatr 164: 135–140

    Article  PubMed  CAS  Google Scholar 

  18. Ohlsson A, Walia R, Shah S (2010) Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 4:CD003481

    Google Scholar 

  19. Herrera C, Holberton J, Davis P (2007) Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev 2: CD003480

    Google Scholar 

  20. Gournay V, Savagner C, Thiriez G, Kuster A, Rozé J-C (2002) Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants. Lancet 359: 1486–1488

    Article  PubMed  CAS  Google Scholar 

  21. Mosca F, Bray M, Stucchi I, Fumagalli M (2002) Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants. Lancet 360: 1023–1024

    Article  PubMed  Google Scholar 

  22. Aranda JV, Clyman R, Cox B et al. (2009) A randomized, double-blind, placebo-controlled trial on intravenous ibuprofen L-lysine for the early closure of nonsymptomatic patent ductus arteriosus within 72 hours of birth in extremely low-birth-weight infants. Am J Perinatol 26: 235–245

    Article  PubMed  Google Scholar 

  23. Gournay V, Roze JC, Kuster A et al. (2004) Prophylactic ibuprofen versus placebo in very premature infants: a randomised, double-blind, placebo-controlled trial. Lancet 364: 1939–1944

    Article  PubMed  CAS  Google Scholar 

  24. Aranda JV, Varvarigou A, Beharry K, Bansal R, Bardin C, Modanlou H, Papageorgiou A, Chemtob S (1997) Pharmacokinetics and protein binding of intravenous ibuprofen in the premature newborn infant. Acta Paediatr 86: 289–293

    Article  PubMed  CAS  Google Scholar 

  25. Cooper-Peel C, Brodersen R, Robertson A (1996) Does ibuprofen affect bilirubin-albumin binding in newborn infant serum? Pharmacol Toxicol 79: 297–299

    Article  PubMed  CAS  Google Scholar 

  26. Ahlfors CE (2004) Effect of ibuprofen on bilirubin-albumin binding. J Pediatr 144: 386–388

    Article  PubMed  CAS  Google Scholar 

  27. Ahlfors CE, Marshall GD, Wolcott DK, Olson DC, von Overmeire B (2006) Measurement of unbound bilirubin by the peroxidase test using zone fluidics. Clinica Chimica Acta 365: 78–85

    Article  CAS  Google Scholar 

  28. von Overmeire B, Touw D, Schepens PJC, Kearns GL, Van Den Anker JN (2001) Ibuprofen pharmacokinetics in preterm infants with patent ductus arteriosus. Clin Pharmacol Ther 70: 336–343

    PubMed  Google Scholar 

  29. von Overmeire B, Vanhagendoren S, Schepens PJ, Ahlfors CE (2004) The influence of ibuprofen-lysine on unbound bilirubin plasma levels in preterm neonates. Pediatr Res 55: 474A

    Google Scholar 

  30. Desfrere L, Zohar S, Morville P, Brunhes A, Chevret S, Pons G, Moriette G, Rey E, Treluyer JM (2005) Dose-finding study of ibuprofen in patent ductus arteriosus using the continual reassessment method. J Clin Pharm Ther 30: 121–132

    Article  PubMed  CAS  Google Scholar 

  31. Diot C, Kibleur Y, Desfrere L (2010) Effect of ibuprofen on bilirubin-albumin binding in vitro at concentrations observed during treatment of patent ductus arteriosus. Early Hum Dev 86: 315–317

    Article  PubMed  CAS  Google Scholar 

  32. Watterberg KL, Gerdes JS, Cole CH et al. (2004) Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics 114: 1649–1657

    Article  PubMed  Google Scholar 

  33. Paquette L, Friedlich P, Ramanathan R, Seri I (2006) Concurrent use of indomethacin and dexamethasone increases the risk of spontaneous intestinal perforation in very low birth weight neonates. J Perinatol 26: 486–492

    Article  PubMed  CAS  Google Scholar 

  34. Tatli MM, Kumral A, Duman N, Demir K, Gurcu O, Ozkan H (2004) Spontaneous intestinal perforation after oral ibuprofen treatment of patent ductus arteriosus in two very-lowbirthweight infants. Acta Paediatr 93: 999–1001

    Article  PubMed  CAS  Google Scholar 

  35. Corazza MS, Davis RF, Merrit TA, Bejar R, Cvetnic W (1984) Prolonged bleeding time in preterm infants receiving indomethacin for patent ductus arteriosus. J Pediatr 105: 292–296

    Article  PubMed  CAS  Google Scholar 

  36. von Overmeire B, Van de Broek H, von Laer P, Weyler J, Vanhaesebrouck P (2001) Early versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome. J Pediatr 138: 205–211

    Article  PubMed  Google Scholar 

  37. von Overmeire B, Allegaert K, Casaer A, Debauche C, Decaluwé W, Jespers A, Weyler J, Harrewijn I, Langhendries JP and the MIPS investigators (2004) Prophylactic ibuprofen in premature infants: a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 364: 1945–1944

    Article  PubMed  Google Scholar 

  38. Thalji AA, Carr I, Yeh TF, Raval D, Luken JA, Pildes RS (1980) Pharmacokinetics of intravenously administered indomethacin in premature infants. J Pediatr 97: 995–1000

    Article  PubMed  CAS  Google Scholar 

  39. Shaffer CL, Gal P, Ransom JL, Carlos RQ, Smith MS, Davey AM, Dimaguila MA, Brown YL, Schall SA (2002) Effect of age and birth weight on indomethacin pharmacodynamics in neonates treated for patent ductus arteriosus. Crit Care Med 30: 343–348

    Article  PubMed  CAS  Google Scholar 

  40. Gal P, Ransom JL, Weaver RL, Schall S, Wyble LE, Carlos RQ, Brown Y (1991) Indomethacin pharmacokinetics in neonates: the value of volume of distribution as a marker of permanent patent ductus arteriosus closure. Ther Drug Monit 13: 42–45

    Article  PubMed  CAS  Google Scholar 

  41. Guimarães H, Rocha G, Tomé T, Anatolitou F, Sarafidis K, Fanos V (2009) Non-steroid antiinflammatory drugs in the treatment of patent ductus arteriosus in European newborns. J Matern Fetal Neonatal Med 22 (Suppl 3): 77–80

    Article  PubMed  Google Scholar 

  42. Seyberth HW (1983) Effect of prolonged indomethacin therapy on renal function and selected vasoactive hormones in VLBW infants with symptomatic patent ductus arteriosus. J Pediatr 103: 979–984

    Article  PubMed  CAS  Google Scholar 

  43. Christmann V, Liem KD, Semmekrot BA, van de Bor M (2002) Changes in cerebral, renal and mesenteric blood flow velocity during continuous and bolus infusion of indomethacin. Acta Paediatr 91: 440–446

    Article  PubMed  CAS  Google Scholar 

  44. de Vries NK, Jagroep FK, Jaarsma AS, Elzenga NJ, Bos AF (2005) Continuous indomethacin infusion may be less effective than bolus infusions for ductal closure in very low birth weight infants. Am J Perinatol 22: 71–75

    Article  PubMed  Google Scholar 

  45. Sperandio M, Beedgen B, Feneberg R, Huppertz C, Brüssau J, Pöschl J, Linderkamp O (2005) Effectiveness and side effects of an escalating, stepwise approach to indomethacin treatment for symptomatic patent ductus arteriosus in premature infants below 33 weeks of gestation. Pediatrics 116: 1361–1366

    Article  PubMed  Google Scholar 

  46. Jegatheesan P, Ianus V, Buchh B (2008) Increased indomethacin dosing for persistent patent ductus arteriosus in preterm infants: a multicenter, randomized, controlled trial. J Pediatr 153: 183–189

    Article  PubMed  CAS  Google Scholar 

  47. Su BH, Lin HC, Chiun HY, Hsieh HY, Chen HH, Tsai YC (2008) Comparison of ibuprofen and indomethacin for early-targeted treatment of patent ductus arteriosus in extremely premature infants: A randomized controlled trial. Arch Dis Child 93: F94–99

    Google Scholar 

  48. Lago P, Bettiol T, Salvadori S, Pitassi I, Vianello A, Chiandetti L, Saia OS (2002) Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus: a randomised controlled trial. Eur J Pediatr 161: 202–207

    Article  PubMed  CAS  Google Scholar 

  49. Richards J, Johnson A, Fox G, Campbell M (2009) A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants. Pediatrics 124: e287–292

    Article  PubMed  Google Scholar 

  50. Hirt D, von Overmeire B, Treluyer JM, Langhendries JP, Marguglio A, Eisinger MJ, Schepens P, Urien S (2008) An optimized ibuprofen dosing scheme for preterm neonates with patent ductus arteriosus, based on a population pharmacokinetic and pharmacodynamic study. Br J Clin Pharmacol 65: 629–636

    Article  PubMed  CAS  Google Scholar 

  51. Clyman RI (1996) Recommendations for the postnatal use of indomethacin: An analysis of four separate treatment strategies. J Pediatr 128: 601–607

    Article  PubMed  CAS  Google Scholar 

  52. Shah S, Ohlsson A (2006) Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 1: CD004213

    Google Scholar 

  53. Fowlie PW, Davis PG, McGuire W (2010) Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 7: CD000174

    Google Scholar 

  54. Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A,Vincer M, Wright LL, for the Trial of Indomethacin Prophylaxis in Preterms Investigators (2001) Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med 344: 1966–1972

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Libre de Bruxelles, Erasmus Hospital – ULB, Université, Brussels, Belgium

    Bart Van Overmeire MD, PhD (Head of Neonatal Intensive Care Unit, Professor of Paediatrics)

Authors
  1. Bart Van Overmeire MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Van Overmeire, B. (2011). Controversies Around Treatment of the Open Duct. In: Controversies around treatment of the open duct. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20623-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-20623-8_6

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-20622-1

  • Online ISBN: 978-3-642-20623-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation