RESUMO
BACKGROUND: Ibuprofen (IBU) has proved as effective as indomethacin in the pharmacological closure of hemodynamically significant patent ductus arteriosus (HsPDA), with an efficacy inversely related to gestational age (57-89%). OBJECTIVE: This study aimed to establish whether continuous infusions of IBU could be more effective in very low birth weight infants with no additional adverse effects and reduce the need for surgical ligation. METHODS: A prospective, randomized, double-dummy study was conducted on 112 very low birth weight infants (mean gestational age 27.2 weeks, SD 2; birth weight 1,019 g, SD 330) with HsPDA, 56 of whom were given IBU in conventional 15-min intermittent boluses, while the other 56 were administered IBU as a 24-hour continuous infusion, both at standard doses (10/5/5 mg/kg). Extensive echocardiography was performed before and after treatment, and adverse effects were monitored. RESULTS: Pharmacological PDA closure was achieved after 1 or 2 IBU courses in 36 of 56 infants (64.3%) after bolus administration and in 46 of 55 (83.6%) after continuous infusion (p = 0.020), and in 9 of 26 (34.6%) and 24 of 30 (80.0%), respectively, in the infants with a gestational age of 23-27 weeks (p = 0.006). Sustained pharmacological closure was observed in 38 of 56 infants (67.9%) after bolus IBU and in 47 of 55 (85.5%) after continuous infusion (p = 0.029). Surgical ligation was used less after continuous infusion than after bolus IBU (5.5 vs. 19.6%; p = 0.024). The continuous infusion group had fewer symptoms of necrotizing enterocolitis (NEC), especially in the more preterm infants, while other neonatal morbidity and mortality rates were similar. CONCLUSION: Continuous IBU infusion is more effective than standard boluses for sustained closure of HsPDA, with fewer NEC symptoms and less need for surgical ligation in very low birth weight infants.
Assuntos
Permeabilidade do Canal Arterial/tratamento farmacológico , Permeabilidade do Canal Arterial/fisiopatologia , Ibuprofeno/administração & dosagem , Ibuprofeno/uso terapêutico , Recém-Nascido de muito Baixo Peso , Método Duplo-Cego , Permeabilidade do Canal Arterial/diagnóstico por imagem , Ecocardiografia , Enterocolite Necrosante/epidemiologia , Feminino , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Humanos , Ibuprofeno/farmacologia , Incidência , Recém-Nascido , Infusões Intravenosas , Injeções Intravenosas , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
It was demonstrated that patients who have undergone the Fontan operation can safely undertake exercise training and that this results in an improvement in aerobic capacity. These findings suggest that aerobic training could be useful in the long-term management of these patients to optimize their cardiovascular fitness for more active lives.
