Randomized double-blind controlled trial comparing the effects of ibuprofen with indomethacin on cerebral hemodynamics in preterm infants with patent ductus arteriosus

被引:147
作者
Patel, J
Roberts, I
Azzopardi, D
Hamilton, P
Edwards, AD
机构
[1] Univ London Imperial Coll Sci Technol & Med, Sch Med, Dept Paediat, Div Paediat Obstet & Gynaecol, London W12 0NN, England
[2] Univ London St Georges Hosp, Sch Med, London SW17 0RE, England
关键词
D O I
10.1203/00006450-200001000-00009
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
A prospective randomized controlled trial was performed to compare the effects of ibuprofen with indomethacin on cerebral hemodynamics measured using near infrared spectroscopy in preterm infants during treatment for patent ductus arteriosus. Infants were randomly assigned to three intravenous doses of either indomethacin (0.20-0.25 mg/kg, 12 hourly) or ibuprofen (5-10 mg/kg, 24 hourly) and also received a dose of saline. The primary end points of the study were the effects of the first dose on cerebral blood flow (CBF) and cerebral blood volume. Fifteen infants received indomethacin and 18 received ibuprofen. The group mean (SD) values for CBF (mL.100 g(-1).min(-1)) before and after the first dose of indomethacin were 13.6 (4.1) and 8.3 (3.1), respectively, the change being significant (p < 0.001). In contrast, no significant changes in CBF were observed with the first dose of ibuprofen, the respective before and after values being 13.3 (3.2) and 14.9 (4.7) mL.100 g(-1).min(-1). The median (interquartile range) value for change in cerebral blood volume (mL/100 g) after the first dose in the indomethacin group was -0.4 (-0.3 to -0.6) and in the ibuprofen group was 0.0 (0.1 to -0.1), the difference between the two groups being significant (p < 0.001). Cerebral oxygen delivery changed significantly after the first dose in the indomethacin group but not in the ibuprofen group. Significant reductions in CBF, cerebral blood volume, and cerebral oxygen delivery also occurred after the 24-h dose of indomethacin, but there were no significant changes after the 48-h dose of saline in the indomethacin group or after the 24- and 48-h doses of ibuprofen. The patent ductus arteriosus closure rates after indomethacin and ibuprofen were 93 and 78%, respectively. We conclude that ibuprofen, unlike indomethacin, has no adverse effects on cerebral hemodynamics and appears to mediate patent ductus arteriosus closure.
引用
收藏
页码:36 / 42
页数:7
相关论文
共 50 条
[1]   Pharmacokinetics and protein binding of intravenous ibuprofen in the premature newborn infant [J].
Aranda, JV ;
Varvarigou, A ;
Beharry, K ;
Bansal, R ;
Bardin, C ;
Modanlou, H ;
Papageorgiou, A ;
Chemtob, S .
ACTA PAEDIATRICA, 1997, 86 (03) :289-293
[2]  
BANDSTRA ES, 1988, PEDIATRICS, V82, P533
[3]  
BETKERUR MV, 1981, PEDIATRICS, V68, P99
[4]  
CHEMTOB S, 1993, PEDIATR RES, V33, P336
[5]   DIFFERENCES IN THE EFFECTS IN THE NEWBORN PIGLET OF VARIOUS NONSTEROIDAL ANTIINFLAMMATORY DRUGS ON CEREBRAL BLOOD-FLOW BUT NOT ON CEREBROVASCULAR PROSTAGLANDINS [J].
CHEMTOB, S ;
BEHARRY, K ;
BARNA, T ;
VARMA, DR ;
ARANDA, JV .
PEDIATRIC RESEARCH, 1991, 30 (01) :106-111
[6]   PROSTANOIDS DETERMINE THE RANGE OF CEREBRAL BLOOD-FLOW AUTOREGULATION OF NEWBORN PIGLETS [J].
CHEMTOB, S ;
BEHARRY, K ;
REX, J ;
VARMA, DR ;
ARANDA, JV .
STROKE, 1990, 21 (05) :777-784
[7]  
CHEMTOB S, 1990, DEV PHARMACOL THERAP, V14, P1
[8]   AGE-DEPENDENT CHANGES IN THE RESPONSE OF THE LAMB DUCTUS-ARTERIOSUS TO OXYGEN AND IBUPROFEN [J].
COCEANI, F ;
WHITE, E ;
BODACH, E ;
OLLEY, PM .
CANADIAN JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY, 1979, 57 (08) :825-831
[9]   GUT BLOOD-FLOW VELOCITIES IN THE NEWBORN - EFFECTS OF PATENT DUCTUS-ARTERIOSUS AND PARENTERAL INDOMETHACIN [J].
COOMBS, RC ;
MORGAN, MEI ;
DURBIN, GM ;
BOOTH, IW ;
MCNEISH, AS .
ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 1990, 65 (10) :1067-1071
[10]   MEDICAL-MANAGEMENT OF SMALL PRETERM INFANTS WITH SYMPTOMATIC PATIENT DUCTUS-ARTERIOSUS [J].
COTTON, RB ;
STAHLMAN, MT ;
KOVAR, I ;
CATTERTON, WZ .
JOURNAL OF PEDIATRICS, 1978, 92 (03) :467-473