The fate of ductus arteriosus in infants at 23-27 weeks of gestation: from spontaneous closure to ibuprofen resistance.
BACKGROUND
Some extremely preterm infants experience spontaneous closure of the ductus arteriosus. On the other side, a high percentage (22-30%) of preterm infants born at the lower gestational age fail to respond to a single course of ibuprofen.


OBJECTIVE
To assess if there are clinical characteristics effective as predictive factors for spontaneous closure of the ductus arteriosus, development of patent ductus arteriosus (PDA) and ibuprofen-resistant PDA.


METHODS
A cohort of inborn infants less than 28 weeks of gestation were prospectively studied. We distinguished infants who had spontaneous closure of ductus arteriosus, who developed PDA and who developed ibuprofen-resistant PDA.


RESULTS
We studied 34 infants. Eight infants (24%) had spontaneous closure of PDA, 17 infants (50%) had a closure of PDA following the first ibuprofen course, while 9 infants (26%) failed to respond to the first ibuprofen course. Infants born at 23-25 weeks of gestation were found to have lower likelihood of PDA spontaneous closure, and higher risk of developing PDA refractory to ibuprofen therapy. Sepsis was found to increase significantly the risk of ibuprofen failure in closing PDA.


CONCLUSIONS
An important percentage of extremely preterm infants exhibited spontaneous closure of PDA. Among clinical characteristics lowest gestational ages predict PDA and ibuprofen-resistant PDA, while sepsis predicts only ibuprofen-resistant PDA.
Dani
Carlo
C
Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Florence, Italy. cdani@unifi.It
Bertini
Giovanna
G
Corsini
Iuri
I
Elia
Serena
S
Vangi
Venturella
V
Pratesi
Simone
S
Rubaltelli
Firmino F
FF
D001777:Blood Coagulation / Q000187:drug effects; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging / Q000502:physiology*; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D015150:Echocardiography, Doppler; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007668:Kidney / Q000187:drug effects; D016015:Logistic Models; D011446:Prospective Studies; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen