| Objective To conduct a prospective randomized controlled trial to assess the efficacy and safety of early-targeted treatment of patent ductus arteriosus (PDA) in very low birth weight infants (VLBWIs) with oral ibuprofen.Method61VLBWIs with DA diameter≥1.5mm confirmed by echocardiography were randomly assigned to receive either ibuprofen (10mg/kg) starting at<24hours of life, followed24hours later by a second dose of5mg/kg and48hours later by a third dose of5mg/kg, or nothing. If the infants were diagnosed as symptomatic PDA at Day3-4directed by re-echocardiography,anther course ibuprofen was given. The therapeutic efficacies and adverse effects in both groups were observed.Result There were no significant differences between the birth weight, gestational age, gentle percentage, diameter of DA, the level of cortiso1, CKMB, serum creatinine,platelet count within24hours after birth of two groups(P>0.05, respectively). The early-targeted treatment group (n=30) showed a significant high closure rate of PDA than the control group (n=31)after one course of treatment (73%VS32%,P=0.001), but the PDA closure rate were similar in both groups after two courses of treatment (90%VS77%,P=0.185). There were no significant differences in serum creatinine level and platelet count after ibuprofen between groups (P>0.05).Compared with control group,The early-targeted treatment group had lower incidence of respiratory failure (X2=10.554, P=0.001),cardiac failure (x2=6.608, P=0.01).ventilator dependent at day4(X2=10.238, P=0.001);while the incidence of intraventricular hemorrhage,gastrointestinal bleeding,bronchopulmonary dysplasia were similar (P>0.05).Conclusion Extravenous ibuprofen for the early-targeted PDA treatment in VLBWIs is relatively effective and safe. Compared with the traditional ibuprofen administration strategy, import ing the early-targeted strategy, give the similar doses,can close the DA earlier and decrease cardiopulmonary insufficiency at a acceptable adverse reaction risk. |
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