Introduction Closure of patent ductus arteriosus (PDA) with indomethacin (INDO) in preterm infants is associated with cerebral vasoconstriction leading to a reduction of cerebral perfusion and oxygenation. We have evaluated the efficacy of ibuprofen (IBU) in PDA treatment and compared, using near-infrared spectroscopy (NIRS), the effects of the two drugs on cerebral blood volume (CBV) and oxidized cytochrome oxidase concentration [cytO2].
Method Twenty-four infants of 29 (24-3) wks gestational age (GA), 960 (600-1620) g birth weight (BW), mechanically ventilated for RDS who had echocardiographic evidence of PDA received their first dose of IBU (10mg/kg) at 19 (6-53) hours; 8 infants of 28 (25-30) wks GA, 820 (600-1390) g BW received the first dose of INDO (0.2 mg/kg) at 29 (5-120) hours. Severity of respiratory disease and other clinical variables were comparable. Subsequent doses (max 2) of 5 mg/kg IBU or 0.1 mg/kg INDO were given at 24 h intervals provided no significant renal, gastrointestinal or cerebral side effects developed and platelet count was >50.000/mm3. Near infrared spectroscopy(NIRS) (NIRO 500, Hamamatsu Photonics), was employed to assess changes, relative to pre-treatment, in CBV, calculated from changes in total hemoglobin, and in oxidized cytochrome a,a3 (ΔcytO2), during two hours following administration of the first dose, as a 1 minute infusion.
