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Korean J Pediatr 2017 June;60(6) :175-180.
Published online 2017 June 15.        doi:
Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants
Jeonghee Shin, Eun Hee Lee, Jee Hyun Lee, Byung Min Choi, Young Sook Hong
Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
Corresponding Author: Byung Min Choi ,Tel: +82-31-412-6557, Fax: +82-31-405-8591, Email:
Copyright © 2017 by The Korean Pediatric Society
Purpose: Plasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA).
Methods: Before March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved.
Results: The BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment.
Conclusion: Individualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA.
Keywords: B-type natriuretic peptide | Ibuprofen | Patent ductus arteriosus | Preterm infant
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B-type natriuretic peptide may have a role in the management of patent ductus arteriosus  2018 February;61(2)
The effects of ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants  2006 December;49(12)
Usefulness of Plasma Atrial Natriuretic Peptide Concentration in the Diagnosis of Patent Ductus Arteriosus in Preterm Infants  2000 July;43(7)
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