COMPARATIVE-EVALUATION OF THE EFFECTS OF INDOMETHACIN AND IBUPROFEN ON CEREBRAL PERFUSION AND OXYGENATION IN PRETERM INFANTS WITH PATENT DUCTUS-ARTERIOSUS

Objective: To compare the effects on cerebral perfusion and oxygenatio n of intravenous ibuprofen and indomethacin as treatment for patent du ctus arteriosus in preterm infants. Study design: Sixteen infants rece iving mechanical ventilation (< 31 weeks gestation) with patent ductus arteriosus received either 0.2 mg/kg indomethacin (n = 8) or 10 mg/kg ibuprofen (n = 8) infused over 1 minute. Near-infrared spectroscopy w as used to measure changes in cerebral blood volume and in oxidized cy tochrome oxidase concentration. Cerebral blood flow velocity in the pe ricallosal artery was measured using Doppler ultrasonography. Results: Indomethacin caused a significant reduction of CBV (maximal changes i n cerebral blood volume: -320 +/- 171 mu L/100 gm) and, in four of eig ht patients, a fall in oxidized cytochrome oxidase concentration (maxi mal change in oxidized cytochrome oxidase concentration in the eight p atients: -0.68 +/- 9.98 mu mol/L, NS). Cerebral blood flow velocity fe ll significantly. Ibuprofen caused no significant reduction of cerebra l blood volume, oxidized cytochrome oxidase concentration, or cerebral blood flow velocity, whereas a significant increase of cerebral blood volume (+207 +/- 200 mu L/100 gm) was observed after 60 minutes. Duct us closure was seen in six of eight infants after the first dose of in domethacin and in five of eight infants after the first dose of ibupro fen. The therapeutic cycle involved administration of a second and thi rd dose, provided no side effects occurred. Treatment was effective in all infants. Conclusion: Compared with indomethacin, treatment with i buprofen does not significantly reduce cerebral perfusion and oxygen a vailability; the observed increase in cerebral blood volume requires f urther investigation.