Effects of Ibuprofen on Cerebral and Somatic Regional Tissue Oxygenation, Using Near-Infrared Spectroscopy in Preterm Infants < 1500g with a Patent Ductus Arteriosus

Background: Patent ductus arteriosus (PDA) is a common finding in premature infants, and there are conflicting studies about the indications and benefits for medical or surgical intervention. Near-infrared spectroscopy (NIRS) allows bedside, noninvasive monitoring of tissue perfusion or oxygenation of underlying organs. Objectives: The objective of this study was to investigate the impact of ibuprofen on regional tissue oxygenation in the cerebral and somatic circulation using NIRS in infants medically treated for an hemodynamically significant PDA. Materials and Methods: This was a prospective observational study in the Neonatal Intensive Care Unit of Rotunda Maternity Hospital from May 2011 to April 2012. All infants < 34 weeks and < 1500 g with a PDA confirmed on echocardiogram were enrolled in the study. NIRS sensor was applied at least 1 h pre-treatment and at least 9 h during treatment after the first dose of ibuprofen. Nontreatment patients were infants who met the above criteria, but did not receive ibuprofen. Results: There are a total of 20 recordings for 18 infants; 10 infants received ibuprofen and 10 infants who were not treated. In the treatment group, 1 infant received ibuprofen on two occasions. One infant was initially in the nontreatment group and later received ibuprofen therapy. The mean (standard deviation [SD]) cerebral regional oxygenation (CrO2 %) pretreatment was 68.1 (+/- 6.28) % and during treatment was 68.56 (+/- 6.43) %. The mean (SD) somatic regional oxygenation (SrO2 %) pretreatment was 40.9 (+/25.3) % and during treatment was 48.6 (+/- 20.4) %. In the nontreatment group, the mean (SD) CrO2 was 66.8 (+/- 8.75) % and SrO2 was 45.7 (23.75) %. Conclusion: This study highlights the equipoise and clinical dilemma surrounding managing preterm babies with PDAs. NIRS does not seem to be a helpful adjunct in stratifying those high-risk babies who may benefit from ductal closure, that is, babies where PDA is affecting tissue oxygenation. However, in the one baby who had a significant complication necrotizing enterocolitis, NIRS did identify early a significant change in the somatic oxygenation, 30% drop from baseline. Even when a PDA is considered hemodynamically significant by a Consultant Paediatric Cardiologist, it appears to have little or no effect on CrO2 and SrO2 saturation. In comparison to indomethacin, ibuprofen had little or no effect on CrO2 and SrO2.