Oral ibuprofen prophylaxis for symptomatic patent ductus arteriosus of prematurity.

BACKGROUND: The oral suspension form of ibuprofen has been shown to have the same efficacy and safety as indomethacin in the treatment of symptomatic PDA, however its role is still questionable in the prophylaxis of symptomatic PDA. OBJECTIVES: 1. To assess the efficacy and safety of the drug in the prevention of symptomatic PDA in premature infants. 2. To study its pharmacokinetics-pharmacodynamics relationship. MATERIAL AND METHOD: A randomized, single-blinded, controlled study was performed on premature neonates with a gestational age between 28-32 weeks, birthweight < or = 1500 grams at the neonatal unit, Queen Sirikit National Institute of Child Health from July 2003 to April 2004. Three doses of ibuprofen suspension or placebo were given 24 hours apart. Clinical evaluation was performed daily until the 28th day of life. Echocardiogram was performed prior to the drug administration, on the 3rd and 7th day of life. RESULTS: There were 22 and 20 cases in the ibuprofen and control group respectively. The epidemiologic data between the groups before enrollment showed no significant differences. Prevalence of symptomatic PDA was lower in the ibuprofen than in the control group without any significant side effects (0/22 vs 5/20, p = 0.015 on day 3 and 0/22 vs 6/20, p = 0.006 on day 7). Comparing with the pharmacokinetic study in older children and adult, the present study revealed nearly the same Cmax but longer Tmax and T1/2 in premature neonates. CONCLUSION: Oral ibuprofen suspension could reduce the prevalence of symptomatic PDA without any significant side effects.

Successful treatment of late onset infection due to multi-drug resistant Acinetobacter Lwoffii in a low birth weight neonate using ciprofloxacin.

This report presents the case of a low birth weight neonate with multidrug-resistant Acinetobacter Lwoffii infection who was successfully treated with ciprofloxacin and co-trimoxazole. Use of ciprofloxacin in pediatric populations was reviewed. The infant responded to the antibiotic regimen with sterilized cerebrospinal fluid with no adverse effects attributable to the ciprofloxacin. Although ciprofloxacin has been found to cause irreversible damage to cartilage in laboratory animals, a review of the literature found that this complication rarely occurs in pediatric patients. Ciprofloxacin has been found to be effective in the treatment of multidrug-resistant gram negative infections in pediatric patients, including premature infants. Ciprofloxacin should be considered in the treatment of neonatal infection caused by multidrug-resistant gram-negative organisms.