Müjgan ARSLAN, Timur MEŞE, Füsun ATLIHAN, İsmail Cengiz ÖZTÜRK, Şebnem ÇALKAVUR, Özgür OLUKMAN

Erken doğmuş bebeklerde klinik olarak anlamlı patent duktus arteriyozus tedavisinde oral ibuprofenin etkinliği

Amaç: Çalışmamızda, hastanemizde izlenen erken doğmuş bebeklerde patent duktus arteriyozus (PDA) sıklığının, kendiliğinden kapanma oranlarının, kapanmayanlarda ağızdan ibuprofen tedavisinin etkinliğinin ve yan etkilerinin araştırılması amaçlandı. Gereç ve Yöntem: Eylül 2007-Ocak 2009 arasında 623 erken doğmuş bebek, doğumdan sonra 24-48 saat içinde ekokardiyografiyle (EKO) değerlendirildi. Hemodinamik olarak anlamlı PDA saptanıp kendiliğinden kapanma gerçekleşmeyen hastalara ağızdan ibuprofen ilk gün 10 mg/kg/gün, ikinci ve üçüncü günler 5 mg/kg/gün 24 saat arayla verildi. Duktusu kapanmayan hastalara ikinci kez tedavi uygulandı. Yanıt alınamayanlarda cerrahi ligasyona gidildi. Bulgular: Altı yüz yirmi üç hastanın 100’ünde PDA saptandı (%16). Patent duktus arteriyozus saptanan hastalarda kendiliğinden kapanma oranı %61 idi. Kapanma olmayan ve hemodinamik olarak anlamlı PDA’sı olan 39 hastanın %95’inde ağızdan ibuprofenle kapanma sağlanırken, %5’ine cerrahi uygulandı. Tedaviye bağlı önemli yan etki kaydedilmedi. Gebelik haftası, doğum ağırlığı arttıkça kendiliğinden kapanma arttı. Duktus çapı, sol atriyum/aort kökü oranı arttıkça kendiliğinden kapanma azaldı. Çıkarımlar: Ağızdan ibuprofenin yüksek etkinliği kabul edilebilir yan etkileri, ve düşük maliyeti nedeniyle duktusun kapatılmasında güvenle kullanılabilecek bir tedavi olduğu düşüncesindeyiz.

The efficacy of oral ibuprofen in the treatment of clinically significant patent ductus arteriosus in preterm infants

Aim: This study was designed to investigate the incidence of patent ductus arteriosus (PDA) by echocardiographic examination, to determine spontaneous closure rates, to investigate the efficacy of oral ibuprofen in the treatment of hemodynamically significant PDA and to define potential drug side effects in preterm infants followed at the neonatology department of İzmir Dr. Behçet Uz Children’s Hospital.Material and Method: Between September 2007-January 2009, 623 preterm infants were evaluated by echocardiography within first 24-48 postnatal hours. Oral ibuprofen treatment was administered to patients with clinically and hemodynamically significant PDA at 10 mg/kg/day initial dose, and following second and third doses of 5 mg/kg/day with 24 hours intervals. A second course of ibuprofen was given to patients whose was not closed PDA after the first course. Patients who didn’t respond to the second course underwent surgical ligation. Results: One hundred out of 623 patients were diagnosed as PDA (%16). Spontaneous closure rate was 61%. In ninetyfive percent of remaining 39 patients PDA was closed after oral ibuprofen administration. Five percent had to undergo surgical ligation. We didn’t observe any considerable side effects. As the gestational week and the birthweight increased, spontaneous closure rate increased. On the other hand as the ductal size and the ratio of left atrium to aortic root increased spontaneous closure rate decreased. Conclusions: Data suggest that oral ibuprofen may be a safe, effective and low cost treatment choice in closing PDA because of its reasonable side effects and practical applicability.

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