Abstract
Hemodynamically significant patent ductus arteriosus (hsPDA) has gained increasing clinical importance on account of the increasing chance of survival of very preterm infants. The incidence of hsPDA varies from 40 to 70% on the third day of life [1]. HsPDA is associated with several co-morbidities like bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and death. Since 1976, inhibition of prostaglandin synthesis with indomethacin has been widely used in the prophylactic or curative treatment of hsPDA. Recently, ibuprofen (IBU) has become increasingly used because of a comparable efficacy in promoting ductal closure, with fewer adverse effects on renal, mesenteric and cerebral blood flows [2, 3]. However, a potential side effect of IBU is the decrease of bilirubin binding capacity of albumin and thereby an increased risk of bilirubin neurotoxicity. In many neonatal intensive care units, hsPDA is preferentially treated in the first week of life, typically at the same time when the bilirubin pool is increased. IBU is intensely bound to albumin (95%) and can displace bilirubin from its albumin binding sites at high concentrations in vitro [4–7]. Conversely, though indomethacin is also firmly bound to albumin, it does not seem to affect the bilirubin binding to albumin [8]. Until recently, IBU remained to be evaluated concerning its potential for displacement of bilirubin from albumin in vivo.
Keywords
- Preterm Infant
- Patent Ductus Arteriosus
- Bilirubin Encephalopathy
- Intravenous Ibuprofen
- Bilirubin Binding
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Desfrère, L., Huon, C. (2011). Competitive Inhibition of Bilirubin-Albumin Binding by Ibuprofen. In: Controversies around treatment of the open duct. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20623-8_5
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