Ibuprofen in very preterm infants impairs renal function for the first month of life.

We carried out a study aiming to determine the renal effect of ibuprofen treatment for patent ductus arteriosus (PDA) in very preterm infants during the first month of life. Infants aged 27-31 weeks gestation were enrolled from October 2004 to August 2006. They were assigned to two different groups according to ibuprofen exposure during care of their PDA status assessed by echocardiography. Infants of both groups were matched based on gestational age, Clinical Risk Index for Babies score, birth weight and inclusion center. Renal function was evaluated at baseline and weekly for 1 month. One hundred and forty-eight infants were enrolled. Glomerular filtration rate (GFR) was significantly decreased in the ibuprofen group after treatment withdrawal (GFR on day 7, ibuprofen versus no ibuprofen: 12.8 +/- 6.2 vs. 18.1 +/- 12.1 ml/min/1.73 m(2); P < 0.001). Adjusted analysis proved this decrease to be sustained during the first month of life. Tubular function was also impaired during the first month in ibuprofen-treated infants. Ibuprofen administered for PDA is associated with a decreased GFR during the first month of life. Renal function of infants receiving ibuprofen should be carefully monitored and drugs that are eliminated by glomerular filtration handled cautiously during this period.

Early inhaled nitric oxide improves oxidative balance in very preterm infants.

Inhaled nitric oxide (iNO) improves oxygenation in premature infants, but concern has been raised about its potential oxidative toxicity. We designed this study to assess the oxidative balance in premature infants who were exposed to low dose iNO and the relationship with their clinical outcome on day 28 of life. A total of 274 infants who were <32 wk gestation were randomized at birth to receive 5 ppm of iNO if they presented with hypoxemic respiratory failure. Nonhypoxemic infants were studied as the reference group. Blood samples were withdrawn 24 h apart, within the first 4 d of life, to assess malondialdehyde (MDA) concentration as oxidative stress marker and total plasmatic glutathione (GSH), intraerythrocyte GSH peroxidase, and GSH reductase activities as antioxidant defenses. After 24 h, the rise in MDA was blunted in the iNO group compared with controls and was close to the reference infants. Conversely, GSH was more stable in the iNO group, when there was no difference for the GSH peroxidase and GSH reductase activities. On day 28, Oxygen dependence was linked with a higher increase in MDA as was the risk for death, whereas intraventricular hemorrhage was associated with a higher initial drop in GSH. Early low-dose iNO in hypoxemic preterm infants improves oxidative balance and seems to be clinically beneficial up to day 28 of life.