Comparison of oral ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants.

OBJECTIVE: Intravenous indomethacin is the conventional treatment for patent ductus arteriosus (PDA) in preterm infants; however its use is associated with various side effects such as oliguria, gastrointestinal bleeding and reduction of cerebral perfusion. Intravenous ibuprofen has recently been used to treat PDA in preterm infants without reducing cerebral blood flow or affecting intestinal or renal hemodynamics. Intravenous forms of indomethacin and ibuprofen are not available in Iran. This study aimed to examine and compare the efficacy and safety of oral ibuprofen and oral indomethacin for the treatment of PDA in preterm infants. METHODS: Thirty-six infants (gestational age less than 34 weeks) who had echocardiographically confirmed PDA were enrolled in this study. The patients were randomly administered with three oral doses of either indomethacin (0.2 mg/kg, at an interval of 24 hrs) or ibuprofen (a first dose of 10 mg/kg, followed at an interval of 24 hrs by two doses of 5 mg/kg each) (n=18 each group). The rate of ductal closure, side effects, complications, and the infants' clinical course were recorded. RESULTS: The ductus was closed in all of 18 patients (100%) in the ibuprofen group and in 15 (83.3%) patients in the indomethacin group (P > 0.05). There were no significant differences in the levels of serum blood urea nitrogen and creatinine between the two groups before and after treatment. Necrotizing enterocolitis (NEC) occurred in 3 patients in the indomethacin group and none in the ibuprofen group (P < 0.05). The survival rate at 1 month after treatment was 94% (17/18) in both groups. One infant in the ibuprofen group died from sepsis and one in the indomethacin group died as a result of NEC. CONCLUSIONS: Oral ibuprofen is as effective as oral indomethacin for the treatment of PDA in preterm infants. Oral ibuprofen therapy is associated with a lower incidence of NEC.

Pulse tissue Doppler analysis of tricuspid annular motion in Iranian children.

BACKGROUND: Quantitative assessment of right ventricular (RV) function has been difficult to assess non-invasively secondary to its non-geometric shape and respiratory-variable filling. With recent improvements in ultrasound equipment we are now able to study myocardial velocity changes, which is known as tissue Doppler imaging. OBJECTIVES: To define normal indices of tricuspid pulse tissue Doppler echocardiography imaging in children and infants. METHODS: We enrolled 100 healthy children with the age of 1 month-15 year old who were referred for echocardiography and had no cardiac lesion in primary echocardiography evaluations. Pulse tissue Doppler images of the lateral tricuspid annular motion were recorded using 4-chamber apical view. Simultaneous electrocardiography was used to correct annular motion time with electrical events. RESULTS: Among our patients 9 were under 1 year, 46 between 10 and 15, 36 between 5 and 10, and 9 between 10 and 15. Infants had decreased peak early diastolic annular velocities and early diastolic annular velocity-to-diastolic annular velocity at atrial contraction ratios compared with the older group. Isovolumic relaxation time difference was not significant between two different groups. In this group of patients, deceleration time and isovolumic contraction time were lower too. CONCLUSION: In this study we found out normal values for systolic and diastolic indices of pulse TDI imaging of tricuspid valve in Iranian healthy children. This can be a basis for RV function studies in different congenital cardiac disease.