Ductus arteriosus, patent neonatal

The ductus arteriosus in neonates is highly sensitive to vasodilation by PGEj. Maintenance of a patent ductus may be important hemodynamically in some neonates with congenital heart disease. PGEj (alprostadil, prostin vr pediatric) is highly effective for palliative, but not definitive, therapy to maintain temporary patency until surgery can be performed. Apnea is observed in —10% of neonates so treated, particularly those who weigh <2 kg at birth. 

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

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

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. 

Indomethacin is FDA approved for closure of persistent patent ductus arteriosus. A typical regimen involves the intravenous administration of 0.1 to 0.2 mg/kg every 12 hours for three doses. Successful closure can be expected in more than 70% of neonates treated with the drug. Such therapy is indicated primarily in premature infants who weigh between 500 and 1750 g, who have a hemodynami-cally significant patent ductus arteriosus, and in whom other... 

Premature infants who require ligation of a patent ductus arteriosus (PDA) or who present with necrotizing enterocolitis (NEC) often weigh less than 1 kg and are not on conventional ventilators, thus often cannot be moved from the neonatal intensive care imit and cannot tolerate an anesthesia machine or a volatile anesthetic. 

Liver Ibuprofen has been hnked with hyperbilirubinemia in preterm neonates. In a retrospective comparison of 418 preterm infants receiving ibuprofen prophylaxis of patent ductus arteriosus and 288 infants who were not treated with ibuprofen those who received ibuprofen had a higher peak serum bilirubin concentration, needed more phototherapy, and had a longer duration of phototherapy [43. ... 

H)fpokalemia, hyponafraemia, h)fpomagnesaemia, renal insufficiency, immune thrombocytopenia, severe myalgia, prolonged QT interval, neonatal nephrocalcinosis and symptoms related to persistent patent ductus arteriosus Competitive inhibition of warferin metabolism by torsemide. 

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