A comparison of oral ibuprofen and intravenous indomethacin for closure of patent ductus arteriosus in preterm infants.

BACKGROUND: Indomethacin is widely accepted as the treatment for patent ductus arteriosus (PDA) in preterm infants but it has various side effects. Ibuprofen is the alternative treatment and believed to be less likely to induce side effects. OBJECTIVE: To compare efficacy and side effects of ibuprofen versus indomethacin treatment for symptomatic patent ductus arteriosus (PDA) in preterm infants. METHOD: The authors studied 30 infants (gestational age < or = 35 weeks, aged < or = 10 days) who were diagnosed as having symptomatic PDA confirmed by echocardiogram. The infants were randomly assigned to receive three intravenous doses of indomethacin given at 12-hour intervals or three doses of ibuprofen given at 24-hour intervals, starting within ten days of life. The demographic data, rate of clinical closure, need for additional treatment, side effects, complications and the infants' clinical course were recorded within 28 days. RESULTS: The rate of ductal closure was similar with the two treatment regimes. Ductal closure occurred in 7 of 15 infants given ibuprofen (46.67%) and 10 of 15 infants given indomethacin (66.67%). (Relative risk 0.669; 95% confidence interval, 0.328 to 1.364; p = 0.462) The number of infants who needed a second pharmacologic treatment was not significantly different between the two groups, (6 cases in the ibuprofen group, 5 cases in the indomethacin group) but surgical ligation was performed in two cases in the indomethacin group. There was a significant difference in using the diuretic drug (furosemide) in the indomethacin group (11 cases), compared to the ibuprofen group (3 cases), (p = 0.009). More cases of necrotizing enterocolitis were seen in the indomethacin group (66.67% compared to 40% in the ibuprofen group) but there was no statistically significant difference. CONCLUSION: Ibuprofen has the same efficiency as indomethacin for the treatment of symptomatic patent ductus arteriosus in preterm infants and less likely to induce necrotizing enterocolitis and renal toxicity than indomethacin.

Treatment of Kawasaki disease using locally product intravenous immunoglobulin.

BACKGROUND: Kawasaki disease (KD) is an acute febrile illness of unknown origin. Several kinds of IVIG have been shown to be effective in the decrease of the incidence of coronary artery abnormalities (CAA) which is the most serious complication. Nowadays, the National Blood Centre, Thai Red Cross Society can manufacture IVIG from the plasma of Thai blood donors which is much cheaper than the imported intravenous immunoglobulin (IVIG's). The effectiveness of this Thai Red-Cross IVIG in Kawasaki disease has never been documented. OBJECTIVE: To determine the initial treatment response and prevalence of CAA in KD treated with a high dose (2 g/kg) of Thai Red-Cross IVIG. PATIENTS AND METHOD: All patients with a diagnosis of KD who had initial treatment with 2 g/kg of Thai Red-Cross IVIG at Queen Sirikit National Institute of Child Health from December 2001 to February 2003 were reviewed retrospectively. RESULTS: All 22 cases (100%) had good response to a single treatment with a high dose of IVIG. The only patient who did not complete the IVIG treatment had a severe reaction following the administration of the drug and needed discontinuation and intervention. During the convalescent phase, there were only 2 cases (9.09%) with CAA in the first month and 1 case (4.55%) at the 3-month follow-up. This only case with CAA at 3 months had multiple aneurysms at the left main and left anterior descending coronary arteries. No giant aneurysms were found in the present study. CONCLUSION: The efficacy of a high dose (2 g/kg) of Thai Red-Cross IVIG in Kawasaki disease is excellent. However, the severe reaction in one patient needs further surveillance.

Balloon atrial septostomy at Queen Sirikit National Institute of Child Health in the year 2001.

BACKGROUND: Balloon atrial septostomy (BAS) is a safe and effective palliative procedure for patients with cyanotic congenital heart disease. The first BAS in Thailand was performed in 1987 at our institute and there have been many changes since that time. OBJECTIVE: To evaluate the immediate and intermediate outcomes of BAS in the new century. PATIENTS AND METHOD: Thirty patients who underwent BAS from January to December 2001 were included in this study. Epidemiologic data, echocardiographic diagnosis, changing techniques from the previous report and the clinical course for patients were reviewed. The end point of follow-up for this study was December 2002. RESULTS: Thirty patients underwent BAS from January to December 2001 with an age range from 1 to 213 days (mean 30.40 +/- 41.97 days). BAS was selectively tried via the umbilical vein in 6 cases. This was successful in 4 cases. Others were performed successfully via the femoral vein. The most common diagnoses were complete transposition of the great arteries (TGA), pulmonary atresia (PA) with intact ventricular septumand transposition of the great arteries with ventricular septal defect (TGA, VSD) respectively. No immediate complications were found in the present study. There were 5 deaths prior to surgery and 2 post-operative deaths accounting for a total mortality of 23.3 per cent. CONCLUSION: BAS is a safe and effective palliative procedure for patients with various types of cyanotic congenital heart disease even in infants up to 7 months of age. The umbilical venous route can be used effectively without significant problems. Although the overall mortality is high, it is not related to BAS.