Differential effects of ibuprofen and indomethacin on cerebral oxygen kinetics in the very preterm baby
Background Ibuprofen is preferred to indomethacin for treatment of a significant patent ductus arteriosus (PDA) in preterm babies despite indomethacin being associated with a lower risk of intraventricular haemorrhage. This difference is thought to relate to the discrepant effects of each medication...
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Published in | Frontiers in pediatrics Vol. 10; p. 979112 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Frontiers Media S.A
03.10.2022
|
Subjects | |
Online Access | Get full text |
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Summary: | Background
Ibuprofen is preferred to indomethacin for treatment of a significant patent ductus arteriosus (PDA) in preterm babies despite indomethacin being associated with a lower risk of intraventricular haemorrhage. This difference is thought to relate to the discrepant effects of each medication on cerebral oxygen kinetics yet the effect of ibuprofen on cerebral perfusion is uncertain.
Methods
Forty-eight babies < 30 weeks with a significant PDA, defined by echocardiography, were randomly assigned to either indomethacin or ibuprofen (
n
= 24 per group) and stratified by gestation and chronologic age. Cerebral blood flow [total internal carotid blood flow (TICF)] and oxygen physiology [oxygen delivery (modCerbDO
2
) and consumption (modCerbVO
2
)] were measured using cranial Doppler ultrasound and near-infrared spectroscopy, and cerebral oxygen extraction (cFTOE) calculated, immediately before and following administration. Temporal and treatment related changes were analysed.
Results
A fixed effect of time was seen for TICF (
p
= 0.03) and therefore modCerbDO
2
(
p
= 0.046) and cFTOE (
p
= 0.04) for indomethacin alone. In the indomethacin group, TICF and modCerbDO
2
fell from baseline to 5 and 30 min respectively (TICF
p
< 0.01, cDO
2
p
= 0.01) before increasing from 5 min to 24 h (
p
< 0.01) and 30 min and 24 h (
p
< 0.01) timepoints. cFTOE peaked at 30 min (
p
= 0.02) returning to baseline at 24 h. There was a parallel increase in arterial lactate.
Conclusion
Indomethacin significantly reduces cerebral blood flow soon after administration, resulting in a parallel increase in oxygen extraction and arterial lactate. This implies that the balance of oxygen kinetics at the time of treatment may be critical in very preterm babies with significant PDA. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Reviewed by: Liesbeth Thewissen, University Hospitals Leuven, Belgium; Elisabeth M. W. Kooi, University Medical Center Groningen, Netherlands Edited by: Flora Wong, Monash University, Australia This article was submitted to Neonatology, a section of the journal Frontiers in Pediatrics |
ISSN: | 2296-2360 2296-2360 |
DOI: | 10.3389/fped.2022.979112 |