الفهرس 
FETAL AND NEONATALOnly 14 pages are availabe for public view
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Abstract
P
DA is an essential part of the fetal circulation. Functional closure occurs at 3 days postnatally and anatomical closure occurs at around 3 months. It usually remains open in preterm infants and closure is then dependent upon certain factors.
Failure of the ductus arteriosus to close within 48-96 hours of postnatal age results in left to right shunts across the ductus and over loading of the pulmonary circulation. This may lead to increased risk for intraventricular hemorrhage, necrotizing enterocolitis, deterioration in the respiratory status and failure to thrive.
The present study was designed to evaluate the safety and efficacy of intravenous indomethacin and oral ibuprofen in treatment of PDA in very low birth weight neonates.
The current study was conducted on 40 very low birth weight preterm neonates delivered in Obstetrics and Gynecology Hospital, Ain- Shams University and admitted in NICU in the same hospital, in the period from December 2007 to the April 2009. Neonates were diagnosed as having PDA.
They were subjected to full history taking & complete clinical assessment together with CBC, CRP with titre, serum creatinine, blood urea nitrogen, prothrombin time, partial thromboplastin time, transcranial and abdominal U/S.
Diagnosis of PDA was done clinically &confirmed by 2D Mode color Doppler echocardiography.
They were divided into two groups:
Group I: It included 20 very low birth weight preterm neonates with PDA. They were treated by intravenous indomethacin (0.2 mg/kg/24hrs) for three days in the first 48-96 hours after birth.
The studied neonates were 12 females &8 males, their gestational age ranged from 27 to 32 weeks, their weights ranged from 750 gram to 1250 gram,13 of them were delivered by caesarean section while 7 of them delivered vaginally, postnatal age between 48 and 96 hours.
Group II: It included 20 very low birth weight preterm neonates with PDA. They were treated by oral ibuprofen (10 mg/kg/day for the first day then 5 mg/kg/day for two others days) in the first 48-96 hours after birth.
The studied neonates were 13 females &7 males, their gestational age ranged from 27 to 32 weeks , their weights ranged from 800 gram to 1230 gram,12 of them were delivered by caesarean section while 8 of them delivered vaginally, postnatal age between 48 and 96 hours.
The current study showed that there was no significant difference between the two groups in base- line clinical, laboratory and echocardiographic characteristics before starting treatment. There was no significant difference in gestational age, birth weight, sex, mode of delivery, age at onset of treatment, respiratory status, total fluid intake and urine output.
There was no significant difference in platelet count, creatinine level, blood urea nitrogen, prothrombin time and partial thromboplastin time.
There was no significant difference in ductal shunt or severity of shunting and size of duct.
The study revealed similar efficacy of both drugs in closure of PDA. PDA was closed in 18 of 20 (90%) in premature infants given intravenous indomethacin, 15 (75%) of them after the first course and 3 (15%) after the second course of the same drug. PDA was closed in 18 of 20 (90%) in premature infants given oral ibuprofen, 14 (70%) of them after the first course and 4 (20%) after the second course of the same drug, with no reopening after treatment.
In indomethacin group, a highly significant decrease in the urine output, total leucocytic count, neutrophil count and platelet count and highly significant increase in creatinine level, blood urea nitrogen, prothrombin time and partial thromboplastin time was found after treatment when compared to those before treatment.
In ibuprofen group, a highly significant decrease in neutrophil count and highly significant increase in blood urea nitrogen, significant increase in creatinine level and partial thromboplastin time was found after treatment when compared to those before treatment.
On comparing preterm infants treated with intravenous indomethacin to those treated with oral ibuprofen a highly significant decrease in urine output together with significant increase in serum creatinine was found in the former than the latter.
The current study shows significant decrease in total leucocytic count, platelet count and significant increase in partial thromboplastin time was found in infants treated with intravenous indomethacin when compared with infants treated with oral ibuprofen.
There was a significant increased frequency of gastrointestinal bleeding in infants treated with intravenous indomethacin when compared to infants treated with oral ibuprofen. One preterm infant had bowel perforation in indomethacin group and none in the ibuprofen group.
The current study showed no statistically significant difference between two groups as regards bronchopulmonary dysplasia or mortality rate.