Ductus arteriosus, patent

Drinking, excessive 423 Ductus arteriosus, patent 582 Dwarfism 379... 

Patent ductus arteriosus Failure of the ductus arteriosus to close, resulting in neonatal hypoxemia. 

A newborn infant is being prepared for surgical repair of a patent ductus arteriosus. Which of the following agents may be administered pre-operatively ... 

Pregnancy Category B (ethacrynic acid, torsemide) Category C (furosemide, bumetanide). Since furosemide may increase the incidence of patent ductus arteriosus in preterm infants with respiratory-distress syndrome, use caution when administering before delivery. 

Most drugs are administered to infants and children for the same therapeutic indications as for adults. However, a few drugs have found unique uses in children. Among these are theophylline and caffeine, which are used to treat apnea of prematurity indomethacin, which closes a patent ductus arteriosus and prostaglandin Ej, which maintains the patency of the ductus arteriosus. Paradoxically, drugs such as phenobarbital, which have a sedating action on adults, may produce hyperactivity in children, and some adult stimulant drugs, such as methyl-phenidate, are used to treat children with hyperactivity. 

Neonates having a patent ductus arteriosus can be treated with which agent to induce a relatively rapid closure and thus often avoid surgical intervention ... 

EP4 Patent ductus arteriosus [23], bone resorption [24], suppression of colitis and mucosal damage [25]... 

Mechanism ofActian An NSAID that produces analgesic and anti-inflammatory effects by inhibiting prostaglandin synthesis. Also increases the sensitivity of the premature ductus to the dilating effects of prostaglandins. Therapeutic Effect Reduces the inflammatory response and intensity of pain. Closure of the patent ductus arteriosus. 

Depression, tinnitus, diaphoresis, somnolence, constipation, diarrhea, bleeding disturbances in patent ductus arteriosus Rare... 

Ibuprofen is effective in closing patent ductus arteriosus in preterm infants, with much the same efficacy and safety as indomethacin. The oral and intravenous routes are equally effective for this indication. A topical cream preparation appears to be absorbed into fascia and muscle an... 

Indomethacin was particularly popular for gout and ankylosing spondylitis. In addition, it has been used to accelerate closure of patent ductus arteriosus. Indomethacin has been tried in numerous small or uncontrolled trials for many other conditions, including Sweet s syndrome, juvenile rheumatoid arthritis, pleurisy, nephrotic syndrome, diabetes insipidus, urticarial vasculitis, postepisiotomy pain, and prophylaxis of heterotopic ossification in arthroplasty. 

Lago P et al Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus A randomized controlled trial. Eur J Pediatr 2002 161 202. [PMID 12014386]... 

An apparent association between severe retinopathy of prematurity and dexamethasone therapy has been shown in a retrospective study (SEDA-20, 372 76). Infants treated with dexamethasone required longer periods of mechanical ventilation (44 versus 26 days), had a longer duration of supplemental oxygen (57 versus 29 days), had a higher incidence of patent ductus arteriosus (28/38 versus 18/52), and required surfactant therapy more often for respiratory distress syndrome (17/38 versus 11/52). Prospective, randomized, controlled studies are needed to correct for differences in severity of cardiorespiratory disease. Until such studies are available, careful consideration must be given to indications, dosage, time of initiation, and duration of treatment with dexamethasone in infants of extremely low birthweight. 

Oral ibuprofen is often prescribed in lower doses (< 2400 mg/d), at which it has analgesic but not anti-inflammatory efficacy. It is available over the counter in low-dose forms under several trade names. A topical cream preparation appears to be absorbed into fascia and muscle an (S)( ) formulation has been tested. Ibuprofen cream was more effective than placebo cream for the treatment of primary knee osteoarthritis. A liquid gel preparation of ibuprofen 400 mg provided faster relief and superior overall efficacy in postsurgical dental pain. In comparison with indomethacin, ibuprofen decreases urine output less and also causes less fluid retention than indomethacin. Ibuprofen has been shown to be effective in closing patent ductus arteriosus in preterm infants, with much the same efficacy and safety as indomethacin. Oral ibuprofen is as effective as intravenous administration in this condition. 

A variety of Amplatzer devices are applicable for LAA occlusion including the atrial and ventricular septal defect devices, the patent foramen ovale devices, the patent ductus arteriosus devices, and other arteriovenous fistulae devices. A special fabric-free LAA plug is currently under investigation (Rg. 2). 

Patency of the ductus arteriosus as PGs maintain the patency, indomethacin given to a new-born child with a patent ductus can result in closure, avoiding the alternative of surgical ligation. 

Patent ductus arteriosus Pulmonary oedema Protease/anti-protease imbalance... 

Enalapril, captopril, and lisinopril (and presumably other ACE inhibitors) cross the placenta in pharmacologically significant amounts (17). There is clear evidence of fetotoxicity when ACE inhibitors are used beyond the first trimester of pregnancy. Since continuation of treatment beyond the first trimester carries an excess risk of low fetal birth weight and other more severe complications, it is important to withdraw the ACE inhibitor at this time. Intrauterine growth retardation, oligohydramnios, and neonatal renal impairment, often with a serious outcome, are characteristic (98) failure of ossification of the skuU or hypocalvaria also appear to be part of the pattern (17). There is also evidence that persistence of a patent ductus arteriosus is also more likely to occur. 

Indometacin increased plasma digoxin concentrations in premature neonates with a patent ductus arteriosus (262), but a formal study in healthy adults showed no interaction (263). It may be that pre-existing impairment of renal function is required for this interaction, but this remains to be elucidated. 

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