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 Oral Versus Intravenous Ibuprofen: Which Is Better in Closure of Patent Ductus Arteriosus?

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dr.alatwane
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تاريخ التسجيل : 17/09/2008

مُساهمةموضوع: Oral Versus Intravenous Ibuprofen: Which Is Better in Closure of Patent Ductus Arteriosus?   الثلاثاء مايو 19, 2009 5:22 am











Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e763 (doi:10.1542/peds.2009-0003)


Oral Versus Intravenous Ibuprofen: Which Is Better in
Closure of Patent Ductus Arteriosus?



Omer Erdeve, MD
Tulin Gokmen, MD

Department of Neonatology


Nahide Altug, MD

Department of Pediatric Cardiology


Ugur Dilmen, MD
Neonatal Intensive Care Unit
Dr Zekai Tahir Burak Women's Health Research and Training Hospital
Ankara, Turkey


To the Editor.


We read with great
interest the article by Cherif et al,1
inwhich the authors compared the efficacy and tolerance betweenoral and intravenous ibuprofen in early closure of patent ductusarteriosus
(PDA) in very low birth weight (VLBW) infants. Theyconcluded that
the rate of early ductal closure with oral ibuprofenwas at least as
good as with the intravenous route in VLBW infantsand was
associated with fewer adverse effects.


In Turkey, we have
been using oral ibuprofen in closure of PDAsuccessfully for many
years because of the unavailability ofintravenous forms of
ibuprofen and indomethacin. When we analyzedour PDA cases
retrospectively for the past 4 months, we observedthat the rate of
closure by oral ibuprofen was 77% (10 of 13)in VLBW
infants.


The intravenous form of ibuprofen became availablein
September 2008, and we used it in 9 VLBW infants. Our preliminaryresult
was that 4 were closed, 3 were unclosed, and 2 remainedwith minimal
ductal shunt that showed closure on follow-up (67%closure rate). It
is possible that the slower rate of oral ibuprofenabsorption
together with the longer time to reach peak plasmalevels, compared
with the intravenous route, and prolonged timeof contact enables
oral ibuprofen to exert its pharmacologiceffects longer with
greater effect than by the intravenous route.2





Indomethacin and
ibuprofen in intravenous form are not availablein many countries,
so to use oral ibuprofen when needed seemsto be an alternative
treatment for closing PDA. However, itssafety and pharmacokinetics
have not been demonstrated in detailin studies with large series.
We recently reported transientbut severe acute renal failure
developing in a 1330-g femaleinfant of 31 weeks' gestation to whom
oral ibuprofen was usedand discussed the safety of this drug in
relation to its pharmacokinetics.3
The only study concerning the pharmacokinetics of oral ibuprofenin
preterm infants showed that there was a large interindividualvariability
observed for plasma concentrations and eliminationhalf-life in
these infants.4



Although oral ibuprofen
can be an easy-to-administer, cheap,and efficacious alternative for
treating PDA, renal toleranceof dosing regimens may be critical and
needs to be evaluated,especially in VLBW infants. It is obvious
that large randomized,controlled trials are required to determine
if oral ibuprofenis as efficacious as intravenous formulations
(indomethacinand ibuprofen) in closing a PDA, with reduced or
equivalentadverse effects.






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dr.aljuraisy
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العمل/الترفيه : طبيب أختصاصي طب الأطفال وحديثي الولادة
المزاج : الحمد لله جيد
تاريخ التسجيل : 15/09/2008

مُساهمةموضوع: رد: Oral Versus Intravenous Ibuprofen: Which Is Better in Closure of Patent Ductus Arteriosus?   الثلاثاء مايو 19, 2009 5:41 am


Nice sub. thanks Dr.Salim

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