Prediction of Therapeutic Response to Cyclooxygenase Inhibitors in Preterm Infants with Patent Ductus Arteriosus
Patent ductus arteriosus (PDA) is a morbid condition commonly seen in premature infants. Cyclooxygenase (COX) inhibitors, such as indomethacin and ibuprofen, are often used for the treatment of PDA in preterm infants, and they work by reducing the production of prostaglandin. However, as observed in clinical practice, not all PDAs in preterm infants can be closed using COX inhibitors. Some studies have demonstrated that gestational age, birth weight, B-type natriuretic peptide (BNP), and ductal diameter can predict the therapeutic responsiveness to COX inhibitors. This paper reviews the factors that can predict successful closure of the PDA in preterm infants using indomethacin or ibuprofen and presents new opinions and recent findings on this topic, including the predictive roles of intrauterine growth restriction, timing of the treatment, and the importance of platelet count and arterial pH. We also discuss the prospects for future studies to improve the individualized therapy of PDA in premature neonates.
KeywordsCyclooxygenase inhibitors Patent ductus arteriosus Preterm infant Predict Response
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Neumann R, Schulzke SM, Buhrer C (2012) Oral ibuprofen versus intravenous ibuprofen or intravenous indomethacin for the treatment of patent ductus arteriosus in preterm infants: a systematic review and meta-analysis. Neonatology 102:9–15. https://doi.org/10.1159/000335332 CrossRefPubMedGoogle Scholar
- 10.Boo NY, Mohd-Amin I, Bilkis AA, Yong-Junina F (2006) Predictors of failed closure of patent ductus arteriosus with indomethacin. Singap Med J 47:763–768Google Scholar
- 12.Zhao J, Li M (2014) Progress in pathogenesis of patent ductus arteriosus in preterm infants. Chin J Appl Clin Pediatr 29:60–63Google Scholar
- 14.McPherson C, Gal P, Ransom JL et al (2010) Indomethacin pharmacodynamics are altered by surfactant: a possible challenge to current indomethacin dosing guidelines created before surfactant availability. Pediatr Cardiol 31:505–510. https://doi.org/10.1007/s00246-009-9628-6 CrossRefPubMedGoogle Scholar
- 18.Yoo H, Lee JA, Oh S et al (2017) Comparison of the mortality and in-hospital outcomes of preterm infants treated with ibuprofen for patent ductus arteriosus with or without clinical symptoms attributable to the patent ductus arteriosus at the time of ibuprofen treatment. J Korean Med Sci 32:115–123. https://doi.org/10.3346/jkms.2017.32.1.115 CrossRefPubMedGoogle Scholar
- 19.Gudmundsdottir A, Johansson S, Håkansson S, Norman M, Källen K, Bonamy AK (2014) Timing of pharmacological treatment for patent ductus arteriosus and risk of secondary surgery, death or bronchopulmonary dysplasia: a population-based cohort study of extremely preterm infants. Neonatology 107:87–92CrossRefPubMedGoogle Scholar
- 21.Gao X, Hei M, Yang B et al (2015) The changes of plasma prostaglandins E2 before and after treatment of patent ductus arteriosus in preterm neonates. Chin J Heart Heart Rhythm 3:102–108Google Scholar