Patent Ductus Arteriosus

Dermatologic- Skin irritation, skin lesions

GI- GI disorders

GU- urinary tract infection, reduced urine output

Hematologic- Anemia, IVH all grades, bleeding

Lab test abnormalities- decreased blood urea with hematuria.

Metabolic/Nutrional -hypernatremia, hypoglycemia.

Renal - blood creatinine increased Hepatic - chloestatis, jaundice Miscellaneous- feeding problems, various infections

Preterm infants with suspected infection that is untreated ; preterm infants with congenital heart disease in whom potency of PDA is necessary for satisfactory pulmonary or systemic blood flow e.g pulmonary atresia, severe coarctation of the aorata, preterm infants who are bleeding especially those with active intracranial hemorrhage or GI bleeding, preterm infants with coagulation defects, preterm infants who have or who are suspected of having necrotising enterocolitis, preterm infants with nsignificant renal function impairment.

Special precaution

Bleeding - ibuprofen lysine like other NSAIDs can inhibit platelet aggregation. Observe preterm infants for signs of bleeding. Ibuprofen has been shown to prolong bleeding time ( but within normal range) in healthy adults subjects This effectmay be exaggerated with underlysing hemostatic defects.

Extravasation- carefully administer ibnuprofen lysine to avoid extravascular injection or leakage because the solution may irritate tissues

Long term use- no long term evaluations of infants treated with ibuprofen at duration more than 36 weeks of postconceptual age observation period.

Special risks- ibuprofen lysine may alter the usual signs of infection. Be continously alert and use this drug with extra care in presence of controlled infection. Ibuprofen has been shown to displace bilirubin from albumin binding sites Use with caution in patients with elevated total bilirubin

Indication-

Patent Ductus Arteriosus

Dosage-

Children- Initial dose- 10mg/kg IV followed by 2 doses of 5mg/kg each after 24 and 48 hours A ciourse of therapy in 3 doses administered IV ( administrationm via the umbilical arterial line has not been evaluated.) All doses must be based on birth weight

Overdose-

Symptoms -

Breathing difficulties, coma, drowsiness, irregular heart beat, kidney failure, low blood pressure, seizures and vomiting

Treatment

No specific measures-. Follow the patient for several days because GI ulceration and hemorrhage may occur

Pharmacology

The metabolim of action through which Ibuprofen causes closure of PDA in neonates is not known. In adults Ibuprofen is an inhibitor of prostaglandin synthesis.

Pharmacokinetics

The population volume of distribution value of racemic ibuprofen for premature infants at birth was 320mL/kg

Pregnancy

Not indicated for use in ptrergnant women.

Lactation- Not recommended for use in breast feeding women.