scholarly journals The Comparison Between Intravenous Acetaminophen Versus Oral Ibuprofen in Preterm Newborns With Patent Ductus Arteriosus: A Clinical Trial

2021 ◽  
Author(s):  
Behzad Mohammadpour Ahranjani ◽  
Hosein Dalil ◽  
Zeinab Harif Nashtifani ◽  
Mamak Shariat ◽  
Mohammadrafie Khorgami
Keyword(s):  
Side Effects ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Clinical Status ◽  
Preterm Neonates ◽  
Intravenous Acetaminophen ◽  
Ductal Closure ◽  
Oral Ibuprofen ◽  
Preterm Newborns ◽  
Patent Ductus

Oral ibuprofen has been known as a conventional treatment for closing patent ductus arteriosus (PDA) in preterm newborns. Since the use of it might lead to various side effects, other treatments needed to be evaluated. Therefore in a prospective study, we compared the efficacy and safety of intravenous acetaminophen versus oral ibuprofen for the closure of PDA. In this study which was done prospectively and under control, 50 preterm neonates with gestational ages and weights less than 37 weeks old and 2500 grams, respectively, who had PDA, large enough hemodynamically, were included in the study. The patients were divided into two groups: A (intravenous acetaminophen) & B (oral ibuprofen). The two groups were given at most two 3-day courses of the medication (the second course if necessary) and evaluated at the end of each course by echocardiography so as to determine the response to the treatment at each step. The rate of ductal closure, the need for additional treatment, side effects, complications and the newborn’s clinical status were recorded. The rate of ductal closure in the both groups after one course of treatment was similar and showed no meaningful significance statistically (P=0.306). But that of the side effects was much higher in group B with a P=0.021. Intravenous Acetaminophen is not only as efficacious as oral Ibuprofen for the treatment of PDA in preterm infants, but also is less likely to lead to side effects and complications.

scholarly journals Oral Versus Intravenous Medications for Treatment of Patent Ductus Arteriosus in Preterm Neonates: A Cost-Saving Initiative

2021 ◽  
Vol 26 (3) ◽  
pp. 291-299
Author(s):  
Robert Godin ◽  
Juan Carlos Rodriguez ◽  
Doron J. Kahn
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Cost Savings ◽  
Medication Cost ◽  
Preterm Neonates ◽  
Oral Medications ◽  
Before And After ◽  
Oral Ibuprofen ◽  
Cost Differences ◽  
Patent Ductus

OBJECTIVE The purpose of the study was to quantify cost savings after promoting oral pharmacotherapy for the treatment of hemodynamically significant patent ductus arteriosus (hsPDA). METHODS This was a retrospective before-and-after time series quality improvement study. Oral ibuprofen and acetaminophen use criteria were developed and recommended, rather than the more costly intravenous equivalents. There were 24-month medication use reports generated for both the pre-criteria (Era-1) and the post-criteria (Era-2) implementation phases to identify neonates prescribed hsPDA medications in order to assess cost differences. RESULTS Era-1 had 190 treatment courses in 110 neonates for a total medication cost of $171,260.70. Era-2 had 210 courses in 109 patients for a total medication cost of $47,461.49, yielding savings of $123,799.21 ($61,899.61 annually) after criteria implementation. The reduction in intravenous ibuprofen use in Era-2 accounted for all the savings. CONCLUSION Preferentially prescribing lower-cost oral medications to treat hsPDA led to significant cost savings.

scholarly journals Use of combination therapy with acetaminophen and ibuprofen for closure of the patent ductus arteriosus in preterm neonates

2020 ◽  
Author(s):  
Susan Kimani ◽  
Aimann Surak ◽  
Michael Miller ◽  
Soume Bhattacharya
Keyword(s):  
Adverse Effects ◽  
Combination Therapy ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Combination Group ◽  
Preterm Neonates ◽  
Primary Therapy ◽  
Ductal Closure ◽  
Patent Ductus

Abstract Objective To compare effectiveness and safety of combination therapy (acetaminophen and ibuprofen) to monotherapy (ibuprofen, indomethacin, or acetaminophen alone) in treatment of the patent ductus arteriosus (PDA) in premature neonates. Methods This was a retrospective cohort study of neonates admitted to a tertiary-level neonatal intensive care unit. Included neonates were born at <32 weeks gestation and received pharmacotherapy for PDA closure. Based on the primary therapy received, our cohort was divided into the following four groups: indomethacin alone, ibuprofen alone, acetaminophen alone, and ibuprofen and acetaminophen (in combination). Baseline characteristics, effectiveness, safety, neonatal mortality, and morbidities rates between these groups were compared. Results One hundred and forty neonates were analyzed; 17 received combination therapy, and 123 neonates received monotherapy: 22 (17.9%) ibuprofen, 29 (23.6%) acetaminophen, and 72 (58.5%) indomethacin. The PDA closure rates were 41.7% for indomethacin, 41.2% for combination therapy, 37.9% for acetaminophen, and 31.8% for ibuprofen (P=0.100). Rates of adverse effects were comparable between the groups. Conclusion The rate of ductal closure was not different between combination therapy and monotherapy. The study did not demonstrate any increased adverse effects in the combination group. Future well-designed prospective clinical trials are needed to guide clinical practice.

scholarly journals Ibuprofen for Ductus Arteriosus Months after Birth

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Odile Frauenfelder ◽  
Ingrid M. van Beynum ◽  
Irwin K. M. Reiss ◽  
Sinno H. P. Simons
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Controlled Trials ◽  
Current Case ◽  
Surgical Closure ◽  
Late Closure ◽  
Preterm Newborns ◽  
Potential Use ◽  
Patent Ductus

Ibuprofen is a well-known agent used to treat patent ductus arteriosus in preterm neonates in the first days of life. In the current case report we illustrate the potential use of ibuprofen in two preterm neonates 60 and 88 days after birth, respectively. To our knowledge, this is the first report on the effects of ibuprofen on patent ductus arteriosus in preterm newborns after months of life. These cases suggest that the ductus arteriosus does not become refractory for ibuprofen after the first days of life. Late closure of the duct with ibuprofen might still improve the cardiorespiratory condition and prevent infants from surgical closure. Controlled trials are necessary to further study these findings.

scholarly journals Paracetamol vs Ibuprofen in Hemodynamically Significant Patent Ductus Arteriosus (HsPDA) in Preterms: A Randomized Controlled Trial

2020 ◽  
pp. 6-13
Author(s):  
Hinal A. Sinol ◽  
Alpa N. Parekh ◽  
Jayendra R. Gohil ◽  
Mehul Gosai
Keyword(s):  
Adverse Effects ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Discharge Rate ◽  
Controlled Trial ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Ductal Closure ◽  
Ibuprofen Group ◽  
Patent Ductus

Background and Objective: Hemodynamically significant patent ductus arteriosus (HsPDA) is a common cause of morbidity in preterm infants. Indomethacin and Ibuprofen, which are cyclo-oxygenase (COX) 1, 2 inhibitors are commonly used drugs for closure of HsPDA. As, Ibuprofen has several contraindications, we designed study using oral paracetamol (a peroxidase inhibitor) and compared with oral ibuprofen, for efficacy and safety in relation to closure of HsPDA in preterm infants. Methods: 140 preterm infants (gestational age less than 32 weeks) with HsPDA (confirmed by 2D Echo) were randomly assigned in two groups and received first course of either oral paracetamol (70) or ibuprofen (70). The need for a second course was determined by 2D Echo evaluation. Parameters studied were rate of ductal closure, any adverse effects and discharge rate. Results: Both groups were similar in term of ductal closure after first course (p=0.46) and second course (p=0.59). However, 22 from Ibuprofen group and only 2 from PCM group developed adverse effects (p<0.001). From paracetamol group 58 were discharged, and 12 died; while from ibuprofen group 46 discharged, 24 died (p=0.03). Conclusion: Paracetamol for HsPDA in preterm neonates was associated with good efficacy and better safety; and less deaths, as compared to ibuprofen.

scholarly journals Closure of patent ductus arteriosus with oral acetaminophen in preterm neonates: A randomized trial

2018 ◽  
Vol 5 (02) ◽  
pp. 2034-2044 ◽  
Author(s):  
Homa Babaei ◽  
Rahele Nemati ◽  
Hooman Daryoshi
Keyword(s):  
Side Effects ◽  
Patent Ductus Arteriosus ◽  
Chronic Lung Disease ◽  
Intraventricular Hemorrhage ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Control Group ◽  
Case Group ◽  
Closure Rate ◽  
Patent Ductus

Introduction: Patent ductus arteriosus (PDA) is one of the most common cardiac problems in preterm neonates which could lead to morbidities, such as chronic lung disease, intraventricular hemorrhage and retinopathy. The aim of this study was to evaluate the effect of oral acetaminophen on closure of PDA in preterm neonates. Methods: Sixty-nine neonates with significant PDA (confirmed through echocardiography) were recruited in this study. Ibuprofen and indomethacin were contraindicated in these neonates These newborns were randomly divided into two groups of cases (n=36) and controls (n=33). The case group was treated with oral acetaminophen at a dose of 15 mg/kg/dose every 6 hours for 72 hours. The control group did not receive any intervention. After 72 hours, both groups were re-evaluated by echocardiography. In case of failed closure of PDA, the second course of treatment would be administration of acetaminophen. The main outcome of this study was to evaluate the rate of closure of PDA and the side effects of the acetaminophen. Results: The overall rate of PDA closure in the acetaminophen-receiving group was 94.4%; the ductus arteriosus was closed in 75% of patients with the first course of treatment. Moreover, 19.4% of patients did not respond to the first course of the treatment but their ductus arteriosus was closed with the second course of acetaminophen treatment. Of the patients, 5.6% did not respond to both courses of acetaminophen treatments. For the control group, the closure rate of PDA was 15.1%. Conclusion: The results of the study showed that oral acetaminophen is an effective alternative treatment for PDA in preterm neonates.

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