Systematic review: Intravenous ibuprofen in preterm newborns
Systematic review: Intravenous ibuprofen in preterm newborns
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DOI：
10.1053/j.semperi.2006.04.003
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发表时间：
2006-06-01
影响因子：
3.4
通讯作者：
Thomas, Ronald
中科院分区：
文献类型：
--
作者：
Aranda, J. V.;Thomas, Ronald
异丙肾上腺素是一种非甾体类抗炎药，广泛用于解热、镇痛和治疗关节炎，对新生羔羊动脉导管产生剂量依赖性收缩作用。两种静脉制剂，即布洛芬赖氨酸和布洛芬THAM，已在动脉导管未闭的早产儿中进行了研究。临床试验已经将静脉注射布洛芬与安慰剂或吲哚美辛进行了比较。还评价了该药物给药前后的药效学作用。与安慰剂相比，静脉注射布洛芬可有效闭合PDA，对肾功能的影响极小。一项使用静脉注射布洛芬-THAM的研究显示肾功能下降，NEC和PPHN的风险增加。与吲哚美辛相比，IV布洛芬赖氨酸发挥相似的疗效（75%至93%关闭）。然而，吲哚美辛增加肾功能异常，减少肠系膜和脑血流量和生物能量学。两项临床试验显示，与安慰剂相比，布洛芬并没有降低脑室内出血的发生率。药物消除时间延长（血浆半衰期=约23小时），表明每日一次给药是适当的。剂量探索研究表明，起始剂量为10 mg/kg，随后为5 mg/kg/d，再持续2天，可提供最佳疗效，且不良反应最少。关于布洛芬和吲哚美辛的新生儿数据表明，在生命的第一天，当需要预防IVH时，应使用吲哚美辛而不是布洛芬，因为布洛芬对IVH风险没有影响。在出生后第二天或之后，当需要早期或治疗性PDA闭合时，布洛芬而不是吲哚美辛可能是首选，因为其不良事件特征更好。
Ibuprofen, a nonsteroidal antiinflammatory drug, widely used as antipyretic, antiinflammatory, and analgesic agent and for therapy of arthritis, exerts a dose-dependent constriction of the ductus arteriosus in newborn lambs. Two intravenous preparations, namely ibuprofen lysine and ibuprofen-THAM, have been studied in preterm newborns with patent ductus arteriosus. Clinical trials have compared IV ibuprofen to placebo, or to indomethacin. Pharmacodynamic effects of this drug before and after its administration have also been evaluated. Compared with placebo, IV ibuprofen effectively closed PDA with minimal effect on renal function. One study using intravenous ibuprofen-THAM showed decreased renal function and increased risk of NEC and PPHN. Compared with indomethacin, IV ibuprofen lysine exerted similar efficacy (75% to 93% closure). However, indomethacin increased abnormal renal function and decreased mesenteric and cerebral blood flow and bio-energetics. Two clinical trials showed that ibuprofen did not reduce the incidence of intraventricular hemorrhage compared with placebo. The drug has prolonged elimination (plasma half-life = ca 23 hours), suggesting that once daily dosing is appropriate. Dose finding studies indicate that a starting dose of 10 mg/kg followed by 5 mg/kg/d for 2 more days provides optimal efficacy with the least adverse effects. Neonatal data on ibuprofen and indomethacin indicate that, on the first day of life when IVH prevention is desired, indomethacin and not ibuprofen should be used since ibuprofen has no effect on IVH risk. On or after the second day of postnatal life, when early or therapeutic PDA closure is needed, ibuprofen and not indomethacin is probably the first choice due to its better adverse event profile.