Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant

Boro Theodore; Ouedraogo Paul; Bama Aime; Seghda Arthur; Zagre Nicaise; Zabsonre Patrice; Simpore Jacques

doi:doi:10.11648/j.ajp.20190504.29

| Peer-Reviewed

Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant

Boro Theodore, Ouedraogo Paul, Bama Aime, Seghda Arthur, Zagre Nicaise, Zabsonre Patrice, Simpore Jacques

Published in American Journal of Pediatrics (Volume 5, Issue 4)

Received: 4 November 2019 Accepted: 28 November 2019 Published: 10 December 2019

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.

Published in	American Journal of Pediatrics (Volume 5, Issue 4)
DOI	10.11648/j.ajp.20190504.29
Page(s)	276-280
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Patent Ductus Arteriosus, Preterm Infant, Ibuprofen

References

[1]	N. Evans and L. N. Archer. Post Natal Circulatory Adaptation in Healthy Term and Preterm Neonates. Arch Dis Child. 1990; 65: 24–6.
[2]	R.B. Cotton, M. T. Stahlman, H. W. Bender, and al. Randomized Trial of Early Closure of Symptomatic Patent Ductus Arteriosus in Small Preterm Infants. J Pediatr. 1978; 93: 647-51.
[3]	M. V. Speziale, R. G. Allen, C. R. Henderson, and al. Effects of Ibuprofen and Indomethacin on Regional Circulation in Newborn Piglets. Biol Neonate 1999; 76: 242-52.
[4]	B. V. Overmeire, K. Smets, D. Lecoutere, and al. A Comparison of Ibuprofen and Indomethacin for Closure of Patent Ductus Arteriosus. N Engl J Med. 2000; 343: 674-81.
[5]	A. Ohlsson and P. S. Shah. Paracetamol (acetaminophen) for Patent Ductus Arteriosus in Preterm or Low Birth Weight Infants. Cochrane Database Syst Rev. 2018; 4: CD010061.
[6]	R. I. Clyman. Medical Treatment of Patent Ductus Arteriosus in Premature Infants. In: Long WA, ed. Fetal and Neonatal Cardiology. Philadelphia: WB Saunders, 1990: 682-90.
[7]	R. I. Clyman. Recommendations for the Postnatal Use of Indomethacin: An Analysis of Four Separate Treatment Strategies. J Pediatr. 1996; 128: 601-7.
[8]	A. Varvarigou, C. L. Bardin, K. Beharry, and al. Early ibuprofen Administration to Prevent Patent Ductus Arteriosus in Premature Newborn Infants. JAMA 1996; 275: 539-44.
[9]	M. A. Heymann, M. A. Rudolph, and N. H. Silverman. Closure of the Ductus Arteriosus in Premature Infants by Inhibition of Prostaglandin Synthesis. N Engl J Med. 1976; 295: 530-3.
[10]	W. F. Friedman, M. J. Hirschklau, M. P. Printz, and al. Pharmacologic Closure of the Patent Ductus Arteriosus in Premature Infant. N Engl J Med. 1976; 343: 526-9.
[11]	T. F. Yeh, J. A. Luken, A. Thalji, and al. Intravenous Indomethacin Therapy in Premature Infants with Persistent Ductus Arteriosus – a Double Blind Controlled Study. J Pediatr. 1981; 98: 137-45.
[12]	J. Neu, R. L. Ariagno, J. B Johnson, and al. A double Blind Study of the Effects of Oral Indomethacin in Preterm Infants with Patent Ductus Arteriosus who Failed Medical Management. Pediatr Pharmacol. 1981; 1: 245-9.
[13]	V. Gournay. Management of Patent Ductus Arteriosus in Preterm Infants: An Evidence-Based Approach. Arch Pédiatr. 2017; 24 (2): 175-79.
[14]	A. Ohlsson, R. Walia, and S. S. Shah. Ibuprofen for the Treatment of Patent Ductus Arteriosus in Preterm or Low Birth Weight (or both) Infants. Cochrane Database Syst Rev. 2015; 2: CD003481.
[15]	J. Lee, V. S. Rajdurai, K. W. Tan, and al. Randomized Trial Prolonged Low-Dose versus Conventional-Dose Indometacin for Treating Patent Ductus Arteriosus in Very Low Birth Weight Infants. Pediatrics 2003; 112: 345-350.
[16]	M. V. Betkerur, T. F. Yeh, K. Miller, and al. Indomethacin and its Effects on Renal Function and Urinary Kallikrein Excretion in Premature Infants with Patent Ductus Arteriosus. Pediatrics 1981; 68: 99-102.
[17]	J. M. Rennie, J. Doyle, and R. W. Cooke. Early Administration of Indomethacin to Preterm Infants. Arch Dis Child 1986; 61: 233-8.
[18]	J. Koch, G. Hensley, L. Roy, and al. Prevalence of Spontaneous Closure of the Ductus Arteriosus in Neonates at a Birth Weight of 1000 gram or Less. Pediatrics 2006; 117 (4): 1113–21.
[19]	J. Richards, A. Johnson, G. Fox, and M. Campbell. A Second Course of Ibuprofen is Effective in the Closure of a Clinically Significant PDA in ELBW infants. Pediatrics 2009; 124 (2).
[20]	K. Herrman, C. Bose, K. Lewis, and M. Laughon. Spontaneous Closure of the Patent Ductus Arteriosus in Very Low Birth Weight Infants Following Discharge from the Neonatal Unit. Arch Dis Child Fetal Neonatal Ed. 2009; 94 (1): 48–50.
[21]	R. I. Clyman. Ibuprofen and Patent Ductus Arteriosus. N Engl J Med. 2000; 343 (10): 728–30.
[22]	E. G. Shannon, H. Hamrick, and H. Georg. Patent Ductus Arteriosus of the Preterm Infant. Pediatrics 2010; 125: 1020 – 30.
[23]	C. A. Mason, J. L. Bigras, S. B. O’Blenes, and al. Gene Transfer in Utero Biologically Engineers a Patent Ductus Arteriosus in Lambs by Arresting Fibronectin-Dependent Neointimal Formation. Nat Med. 1999; 5 (2): 176–82.
[24]	C. A. Mason, P. Chang, C. Fallery, and M. Rabinovitch. Nitric Oxyde Mediates LC-3-Dependent Regulation of Fibronectin in Ductus Arteriosus Intimal Cushion Formation. FASEB J. 1999; 13 (11): 1423–34.
[25]	U. Yokoyama, S. Minamisawa, H. Quan, and al. Chronic Activation of the Prostaglandin Receptor EP4 Promotes Hyaluronan-Mediated Neointimal Formation in the Ductus Arteriosus. J Clin Invest. 2006; 116 (11): 3026–34.
[26]	K. N. Ivey and D. Srivastava. The Paradoxical Patent Ductus Arteriosus. J Clin Invest. 2006; 116 (11): 2863–65.
[27]	B. Achanti, T. F. Yeh, and R. S. Pildes. Indomethacin Therapy in Infants with Advanced Postnatal Age and Patent Ductus Arteriosus. Clin Invest Med. 1986; 9 (4): 250–53.
[28]	C. Z. Yang and J. Lee. Factors Affecting Successful Closure of Hemodynamically Significant Patent Ductus Arteriosus with Indomethacin in Extremely Low Birth Weight Infants. World J Pediatr. 2008; 4 (2): 91–96.
[29]	L. Cooke, P. A. Steer, and P. G. Woodgate. Indomethacin for Asymptomatic Patent Ductus Arteriosus in Preterm Infants. Cochrane Database Syst Rev. 2003; 1: CD003745.
[30]	B. K. David. The Treatment of Patent Ductus Arteriosus in Preterm Infants. A Review and Overview of Randomized Trials. Semin Neonatol. 2001; 6: 63–73.
[31]	B. Van Overmeire, P. Vanhaesebrouck, and J. P. Langhendries. Early versus Late Selective Treatment of Patent Ductus Arteriosus in Preterm Infants with Respiratory Distress Syndrome. Ped Res. 1998; 43 (suppl 2): 200.
[32]	K. M. Weesner, R. G. Dillard, R. J. Boyle, and S. M. Block. Prophylactic Treatment of Asymptomatic Patent Ductus Arteriosus in Premature Infants with Respiratory Distress Syndrome. Southern Med J. 1987; 80: 706–708.
[33]	H. Babaei, R. Nemati, and H. Daryoshi. Closure of Patent Ductus Arteriosus with Oral Acetaminophen in Preterm Neonates: a Randomized Trial. Biomedical Research and therapy 2018; 5 (2): 2034-44.
[34]	N. M. Bagheri, P. Niknafs, F. Sabsevari, and al. Comparison of Oral Acetaminophen versus Ibuprofen in Premature Infants with Patent Ductus Arteriosus. Iran J Pediatr. 2016; 26 (4): e3975.
[35]	A. E. El-Mashad, H. El-Mahdy, D. El Amrousy, and M. Elgendy. Comparative Study of the Efficacy and Safety of Paracetamol, Ibuprofen, and Indomethacin in Closure of Patent Ductus Arteriosus in Preterm Neonates. Eur J Pediatr. 2017; 176 (2): 233-40.
[36]	M. Gillam-Krakauer and J. Reese. Diagnosis and Management of Patent Ductus Arteriosus. Neoreviews 2018; 19 (7): 394-402.
[37]	H. Popat, V. Kapoor, and J. Travadi. Patent Ductus Arteriosus in Infants < 29 Weeks Gestation – Outcomes and Factors Affecting Closure. Indian Pediatrics 2011; 49 (8): 615-20.
[38]	G. M. Pacifici. Clinical Pharmacology of Indomethacin in Preterm Infants: Implications in Patent Ductus Arteriosus Closure. Paediatr Drugs 2013; 15: 363–76.
[39]	A. S. Chhina and A. Shenoi. Paracetamol-Responsive Patent Ductus Arteriosus in a Late Preterm Very Low Birth Weight Neonate at 4 Weeks Postnatal Age. Muller J Med Sci Res. 2016; 7: 131-2.
[40]	A. S. Chhina, B. Kumar Sharma, M. Raja, and al. Indomethacin-Responsive Patent Ductus Arteriosus in an Extremely Preterm Infant at 8 Weeks Postnatal Age. Indian J Pediatr. 2015; 82: 655-56.
[41]	C. Hammerman, A. Bin-Nun, E. Markovitch, and al. Ductal Closure with Paracetamol: A Surprising New Approach to Patent Ductus Arteriosus Treatment. Pediatrics 2011; 128: 1618–21.
[42]	W. Sterniste, C. Gabriel, and M. Sacher. Successful Closure of the Patent Ductus Arteriosus by Indomethacin in an Extremely Low Birth Weight Infant of Very Advanced Postnatal Age. Pediatr Cardiol. 1998; 19: 256–8.
[43]	A. E. Baruteau, S. Hascoët, J. Baruteau, and al. Transcatheter Closure of Patent Ductus Arteriosus: Past, Present and Future. Arch Cardiovasc Dis. 2014; 107: 122-32.

Cite This Article

Plain Text BibTeX RIS

APA Style

Boro Theodore, Ouedraogo Paul, Bama Aime, Seghda Arthur, Zagre Nicaise, et al. (2019). Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant. American Journal of Pediatrics, 5(4), 276-280. https://doi.org/10.11648/j.ajp.20190504.29

Copy | Download

ACS Style

Boro Theodore; Ouedraogo Paul; Bama Aime; Seghda Arthur; Zagre Nicaise, et al. Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant. Am. J. Pediatr. 2019, 5(4), 276-280. doi: 10.11648/j.ajp.20190504.29

Copy | Download

AMA Style

Boro Theodore, Ouedraogo Paul, Bama Aime, Seghda Arthur, Zagre Nicaise, et al. Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant. Am J Pediatr. 2019;5(4):276-280. doi: 10.11648/j.ajp.20190504.29

Copy | Download

@article{10.11648/j.ajp.20190504.29,
  author = {Boro Theodore and Ouedraogo Paul and Bama Aime and Seghda Arthur and Zagre Nicaise and Zabsonre Patrice and Simpore Jacques},
  title = {Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {4},
  pages = {276-280},
  doi = {10.11648/j.ajp.20190504.29},
  url = {https://doi.org/10.11648/j.ajp.20190504.29},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190504.29},
  abstract = {The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant
AU  - Boro Theodore
AU  - Ouedraogo Paul
AU  - Bama Aime
AU  - Seghda Arthur
AU  - Zagre Nicaise
AU  - Zabsonre Patrice
AU  - Simpore Jacques
Y1  - 2019/12/10
PY  - 2019
N1  - https://doi.org/10.11648/j.ajp.20190504.29
DO  - 10.11648/j.ajp.20190504.29
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 276
EP  - 280
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20190504.29
AB  - The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.
VL  - 5
IS  - 4
ER  -

Copy | Download

Author Information

Boro Theodore

Cardiology Unit, Saint Camille Hospital, Ouagadougou, Burkina Faso
Ouedraogo Paul

Department of Neonatology, Saint Camille Hospital, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
Bama Aime

Cardiology Unit, Charles De Gaulle Paediatric University Hospital, Ouagadougou, Burkina Faso
Seghda Arthur

Department of Cardiology, Bogodogo University Hospital, Ouagadougou, Burkina Faso
Zagre Nicaise

Department of Neonatology, Saint Camille Hospital, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
Zabsonre Patrice

Department of Cardiology, Yalgado Ouedraogo University Hospital, University Ouaga I Prof. Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
Simpore Jacques

Department of Microbiology and Biochemistry, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Ouaga I Prof. Joseph Ki-Zerbo, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Boro Theodore, Ouedraogo Paul, Bama Aime, Seghda Arthur, Zagre Nicaise, et al. (2019). Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant. American Journal of Pediatrics, 5(4), 276-280. https://doi.org/10.11648/j.ajp.20190504.29

Copy | Download

ACS Style

Boro Theodore; Ouedraogo Paul; Bama Aime; Seghda Arthur; Zagre Nicaise, et al. Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant. Am. J. Pediatr. 2019, 5(4), 276-280. doi: 10.11648/j.ajp.20190504.29

Copy | Download

AMA Style

Boro Theodore, Ouedraogo Paul, Bama Aime, Seghda Arthur, Zagre Nicaise, et al. Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant. Am J Pediatr. 2019;5(4):276-280. doi: 10.11648/j.ajp.20190504.29

Copy | Download

@article{10.11648/j.ajp.20190504.29,
  author = {Boro Theodore and Ouedraogo Paul and Bama Aime and Seghda Arthur and Zagre Nicaise and Zabsonre Patrice and Simpore Jacques},
  title = {Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {4},
  pages = {276-280},
  doi = {10.11648/j.ajp.20190504.29},
  url = {https://doi.org/10.11648/j.ajp.20190504.29},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190504.29},
  abstract = {The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant
AU  - Boro Theodore
AU  - Ouedraogo Paul
AU  - Bama Aime
AU  - Seghda Arthur
AU  - Zagre Nicaise
AU  - Zabsonre Patrice
AU  - Simpore Jacques
Y1  - 2019/12/10
PY  - 2019
N1  - https://doi.org/10.11648/j.ajp.20190504.29
DO  - 10.11648/j.ajp.20190504.29
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 276
EP  - 280
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20190504.29
AB  - The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.
VL  - 5
IS  - 4
ER  -

Copy | Download