Korean J Pediatr.  2017 Jun;60(6):175-180. 10.3345/kjp.2017.60.6.175.

Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants

• Shin J
• Lee EH
• Lee JH
• Choi BM
• Hong YS

• KMID: 2383996
• DOI: http://doi.org/10.3345/kjp.2017.60.6.175

Abstract

PURPOSE
Plasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA).
METHODS
Before March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved.
RESULTS
The BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment.
CONCLUSION
Individualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA.

Keyword

B-type natriuretic peptide; Ibuprofen; Patent ductus arteriosus; Preterm infant

MeSH Terms

Cyclooxygenase Inhibitors
Ductus Arteriosus, Patent*
Humans
Ibuprofen*
Indomethacin
Infant
Infant, Newborn
Infant, Premature*
Ligation
Natriuretic Peptide, Brain*
Plasma
Cyclooxygenase Inhibitors
Ibuprofen
Indomethacin
Natriuretic Peptide, Brain