Renal safety of Non Steroidal Anti Inflammatory Drugs (NSAIDs) in the pharmacologic treatment of patent ductus arteriosus

Non-steroidal anti-inflammatory drugs (NSAID) have been used to close the patent ductus arteriosus in neonates for over two decades. Ibuprofen lysine, a parenteral NSAID, is labeled for the treatment of patent ductus arteriosus in neonates who do not respond to conventional medical management. While sharing many of the same adverse effects as indomethacin, spontaneous bowel perforation has not been reported. We describe a premature infant that experienced isolated bowel perforations after treatment with ibuprofen lysine for symptomatic patent ductus arteriosus.

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Acute kidney injury among preterm infants receiving non-steroidal anti-inflammatory drugs for patent ductus arteriosus

10.21203/rs.3.rs-110803/v1 ◽

2020 ◽

Author(s):

Joseph Ting ◽

Kate McDougal ◽

Alanna De Mello ◽

Eddie Kwan ◽

Cherry Mammen

Keyword(s):

Acute Kidney Injury ◽

Treatment Group ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Kidney Injury ◽

Prophylaxis Group ◽

Increased Risk ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Patent Ductus

Abstract Background: Nonsteroidal anti-inflammatory drugs (NSAID) are a frequently prescribed class of medication in the neonatal intensive care unit (NICU). Hospitalized patients receiving NSAID therapy are at an increased risk of acute kidney injury (AKI). Our primary objective was to reveal AKI epidemiology in NSAID-exposed premature infants admitted to the NICU using a standardized definition.Methods: This retrospective study included infants born at ≤34 weeks gestational age who received NSAID for intraventricular haemorrhage prophylaxis [“prophylaxis group”] or symptomatic treatment for patent ductus arteriosus (PDA) [“treatment group”] between January and December 2014 at British Columbia Women’s Hospital NICU. All available serum creatinine (SCr) and 12-hour urine output (UO) were recorded from admission till day 7 post NSAID exposure. AKI incidence was determined using the modified Kidney Disease: Improving Global Outcomes (KDIGO) classification with an increase in SCr (ΔSCr) (50% rise from prior SCr within 7 days or 26.5 mmol/L rise within 48 hours) and/or UO < 1 mL/kg/hour, excluding the first 24 h of life.Results: We identified 70 eligible subjects, 32 of whom received prophylactic NSAID (prophylaxis group), and 38 received indomethacin or ibuprofen for treatment of symptomatic PDA (treatment group), with an overall AKI incidence of 23% (16/70). The treatment group had a higher proportion of infants with SCr monitoring during the NSAID than the prophylaxis group (87% vs. 13%, p<0.001). Based upon the above defined criteria (fulfilling at least one—either the UO or SCr monitoring criteria), the prophylaxis group had a significantly lower AKI rate compared with the treatment group (9% vs. 34%; p=0.014). Conclusions: AKI incidence is higher in infants treated with NSAID for symptomatic PDA than in those treated prophylactically during the first day of life, based on the criteria applied. However, the burden of AKI may be underestimated in the prophylaxis group due to fewer available SCr values after exposure, and inability to utilize UO criteria in the 1st 24 hours of life. Standardized protocols for monitoring daily SCr and UO after exposure should be implemented for all neonates with NSAID exposure and should be considered to improve AKI recognition.

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Non-steroidal Anti-inflammatory Drugs (NSAIDs) in the Management of Patent Ductus Arteriosus (PDA) in Preterm Infants and Variations in Attitude in Clinical Practice: A Flight Around the World

Current Medicinal Chemistry ◽

10.2174/0929867321666140304095434 ◽

2014 ◽

Vol 21 (27) ◽

pp. 3132-3152 ◽

Cited By ~ 12

Author(s):

R. Irmesi ◽

M.A. Marcialis ◽

J.V.D. Anker ◽

V. Fanos

Keyword(s):

Clinical Practice ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Ductus Arteriosus ◽

The World ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Patent Ductus

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Management of patent ductus arteriosus: A comparison of operative V pharmacologic treatment

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(87)80730-3 ◽

1987 ◽

Vol 22 (12) ◽

pp. 1171-1174 ◽

Cited By ~ 41

Author(s):

Steven B. Palder ◽

Marshall Z. Schwartz ◽

Kenneth R.T. Tyson ◽

Clifford C. Marr

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Pharmacologic Treatment ◽

Patent Ductus

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Nonrheumatologic Uses of NSAIDS

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808401800107 ◽

1984 ◽

Vol 18 (1) ◽

pp. 52-55 ◽

Cited By ~ 6

Author(s):

Ronald P. Evens

Keyword(s):

Adverse Effects ◽

Patent Ductus Arteriosus ◽

Water Retention ◽

Ductus Arteriosus ◽

Side Effect Profile ◽

Skin Reactions ◽

The Past ◽

Asthma Patients ◽

Inflammatory Drugs ◽

Patent Ductus

Nonsteroidal anti inflammatory drugs (NSAIDs) have several salient indications outside of their role in rheumatology. Two major uses are treatment of dysmenorrhea and patent ductus arteriosus. Other established roles encompass treatment of fever, pain, Banter's syndrome, and thromboembolic disorders. Animal and human studies are being done on the use of NSAIDs in cancer, diabetes, psoriasis, and shock, just to name a few investigative areas. NSAIDs are not a panacea nor are they wonder drugs to be used indiscriminately. When these drugs first were marketed in the 1970s, they were considered safe agents with little toxicity. However, the side-effect profile of the NSAIDs has been, and continues to be, better identified over the past few years and warrants judicious use of these drugs. Their adverse effects potentially include gastric distress (possibly hemorrhage), allergic urticaria or bronchospasm in asthma patients, azotemia, arrested labor, skin reactions, and water retention. NSAIDs are relatively safe agents with a growing list of new indications. Future clinical evaluation holds the key to the balance between their emerging toxicities and indications.

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