Therapeutic closure of the ductus arteriosus: benefits and limitations.

Détails

ID Serval
serval:BIB_CB6007665334
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Therapeutic closure of the ductus arteriosus: benefits and limitations.
Périodique
Journal of Maternal-fetal and Neonatal Medicine
Auteur(s)
Mercanti I., Boubred F., Simeoni U.
ISSN
1476-4954 (Electronic)
ISSN-L
1476-4954
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
22
Numéro
Suppl 3
Pages
14-20
Langue
anglais
Notes
Publication types: Journal Article ; Review Publication Status: ppublish
Résumé
Patency of the ductus arteriosus (PDA), a common complication of preterm birth, has been associated to increased risk for intraventricular cerebral hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and death. Consequently, prophylactic or curative treatment has been advocated before the critical left-to-right shunting occurs. A host of studies has shown that both pharmacological agents and surgical closure are effective in closing the ductus arteriosus in premature infants. Indomethacin has long been the drug of choice. However, renal and cerebral haemodynamic side effects have been frequently reported. Strategies to minimise adverse effects of indomethacin, such as the association with frusemide, dopamine or the use of low-dose prolonged treatment with indomethacin have failed or shown partial benefit. Other NSAIDs have been investigated. But either the profile of adverse effects was unfavourable, as in the case of mefenamic acid, or their efficacy was less than that of indomethacin for PDA closure. More recently, ibuprofen has been proposed for the treatment of PDA as it was shown to induce less adverse effects on cerebral blood flow, intestinal and renal hemodynamics, while retaining similar efficacy to indomethacin. However, since renal perfusion, GFR and diuresis in early neonatal life strongly depend on the vasodilator effects of PGs on the afferent glomerular arterioles, ibuprofen, as other COX-inhibitors may not be exempt of some renal undesirable effects. While numerous studies have shown that PDA is a risk factor associated with immaturity and with increased incidence of complications of preterm birth, including broncho-pulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis and death, there is little evidence that such association is causative. Moreover, still little evidence exists from even recent randomized controlled trials that the pharmacological closure of PDA benefits to premature infants in terms of clinically significant short-term or medium-term outcomes, beyond a positive effect on DA patency. The use of COX-inhibitors for the prophylaxis or closure of PDA during the first hours or days of life should thus be cautious and based on an individual evaluation of benefit and risk. There is need of a randomized, placebo-controlled trials designed to assess the benefits in terms of mortality and morbidity outcomes of an early, or even very early pharmacological closure of PDA in extremely low gestational age infants.
Mots-clé
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Ductus Arteriosus, Patent/drug therapy, Ductus Arteriosus, Patent/physiopathology, Evidence-Based Medicine, Gestational Age, Humans, Ibuprofen/therapeutic use, Indomethacin/therapeutic use, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases/drug therapy, Infant, Premature, Diseases/physiopathology
Pubmed
Web of science
Création de la notice
22/02/2015 11:06
Dernière modification de la notice
03/03/2018 21:26
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