Early Targeted Therapy Of Patent Ductus Arteriosus With Ibuprofen And Hydrocortisone In Premature Infants With Low Cortisol Concentration

Objective：1. Finding the relationship between early targeted therapy in prematureinfants with low cortisol concentration and PDA；2. Evaluation the role of ibuprofenand hydrocortisone in early targeted therapy of PDA.Method：We performed a prospective randomized controlled trial on144very lowbirth weight infants with gestational ages of28~32weeks and birth weight of1000~1500grams，who were diagnosed haemodynamically non-significant PDA byechocardiography，introducing early targeted therapy including ibuprofen and/orhydrocortisone within the first24hours after birth. According to the baseline of serumcortisol concentrations measured prior to the administration of the treatment，thepreterm were divided into two groups，low cortisol lever group（<15ug/dl）whichdivided into four groups further each being allocated to hydrocortisone or ibuprofenor both of hydrocortisone and Ibuprofen combined therapy or placebo treatment；highcortisol lever group（15ug/dl）which allocated to either ibuprofen or placebo therapyin randomization. Diameter of ductus arteriosus and cortisol value were measuredagain when the end of treatment. All data was collected and analyzed by statisticalsoftware.Result：Low cortisol lever group，combined therapy，closure of the ductus at a rate of81%，was higher than another therapy(P=0.000)；high cortisol lever group，the ductusarteriosus closed in20patients of ibuprofen therapy(74.1%)and in13patients ofplacebo treatment(50.0%)（P=0.02）. Early targeted therapy did not significantlyincrease the adverse effects of drugs. After comparisons between laboratory changesfollowing treatment in early targeted groups and non-early targeted groups，findingswere as follows：decrease in the incidence of apnea、myocardial damage、feedingintolerance、intraventricular hemorrhage and reduce the time of phototherapy. Thecovariance analysis which to eliminate several influence factors indicated that theusage of hydrocortisone or ibuprofen and the closure of ductus arteriosus will notaffect the second cortisol concentration（P=0.216、P=0.257、P=0.395）. Conclusion：This trial proved the efficacy and safety of early targeted therapyincluding ibuprofen and/or hydrocortisone for closure of ductus arteriosus andreduction incidence of the negative outcome because of PDA.