Togtema, M. (Marije) (2017) The Effect of Ibuprofen on the Cerebral and the Splanchnic Oxygen Saturation as Treatment for Patent Ductus Arteriosus in Preterm Infants. thesis, Medicine.
Full text available on request.Abstract
Background. The ductus arteriosus (DA) connects the pulmonary artery to the proximal descending aorta in the developing fetus. After delivery in term born infants the DA usually closes within 24 – 48 hours. However in preterm infants the DA often fails to close, with the production of prostaglandins by cyclooxygenase as most important mechanism keeping the ductus patent. A patent ductus arteriosus (PDA) is associated with complications of prematurity, such as pulmonary edema and hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia and death. Pharmacologic treatment of a PDA consists of COX inhibitors, INDO and IBU. IBU is the preferred treatment of PDA. However, the reports on the systemic vasoconstrictive effect of IBU are inconsistent and the effect of the closing DA was not taken into account in most studies. Vasoconstriction in various organs might induce hypoxia within those organs. Hypoxia could induce several complications, such as NEC. Whether the change in blood flow, due to a PDA, or the vasoconstrictive effect of IBU on the systemic circulation contributes to development of these complications is not clear. Objective. The aim of this study was to determine the effect of IBU administration on the cerebral and splanchnic oxygen saturation in preterm infants, in whom the PDA failed to close after treatment with IBU, unraveling the effect of a PDA versus the effect of IBU treatment on the regional oxygen saturation. Secondary aim was to investigate the cerebral and splanchnic oxygen saturation during the IBU administration. Our third aim was to investigate if there are any secondary clinical parameters that correlate with the cerebral and splanchnic oxygen saturation during and after treatment with IBU. Research design and methods. In this combined retrospective and prospective study we included preterm infants with a gestational age (GA) < 32 weeks and/or birth weight (BW) < 1200 grams admitted at the NICU at the UMCG, who still have a hsPDA after treatment with IBU. In these preterm infants we measured the cerebral and splanchnic oxygen saturation in the four hours before IBU administration, two hours during the effect of IBU administration and four hours after IBU administration with near-infrared spectroscopy (NIRS). The arterial oxygen saturation (SpO2) was measured simultaneously. To investigate the balance between oxygen delivery and oxygen consumption, the fractional tissue oxygen extraction (FTOE) can be calculated. We calculated the FTOE using the following formula: FTOE = (SpO2-RSO2)/SpO2. We also collected patients characteristics and demographic and clinical variables. Results. A total of 30 preterm infants matched our inclusion criteria. The median gestational age (GA) was 24+6 weeks [range: 24+0 – 27+2] and the median birth weight (BW) was 808 grams [range: 540 – 1435]. The median day of treatment was 5 [range: 2 – 13]. There were no significant differences between the cerebral and splanchnic oxygen saturation before IBU administration, during the effect of IBU administration and after IBU administration. The fractional cerebral tissue oxygen extraction during and after administration of IBU was significant lower than the fractional cerebral tissue oxygen extraction before administration of IBU. The course of both the cerebral and splanchnic oxygen saturation during IBU administration and the effect of IBU administration showed no significant difference. Conclusion. In this study, IBU has no significant vasoconstrictive effect on the cerebral and splanchnic oxygen saturation. However, the effect of IBU on the splanchnic oxygen saturation during administration is still unclear.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kooi, Elisabeth M. W. and University of Groningen and University Medical Center Groningen and Department of Neonatology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2281 |
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