A full-term infant with large patent ductus arteriosus successfully closed with oral ibuprofen: a case report

Background: Ductus arteriosus is a vascular shunt between the aorta and pulmonary artery. Within the first 24-48 hours of life, the ductus usually closes. Failure of closure is called patent ductus arteriosus (PDA). Timing for treatment is crucial. Early treatment can decrease the need for drugs or surgery, but it can cause more adverse events, such as brain hemorrhage, bowel perforation and renal dysfunction. On the other hand, late treatment can cause complications such as pulmonary hemorrhage, necrotizing enterocolitis and can render drugs to be less effective. Case Presentation: The patient was a 2 hours old male, 39 weeks, Apgar 7/8, 3100 grams, referred to the cardiology team because of tachypnea and peripheral cyanosis.  Initial echocardiographic showed large patent ductus arteriosus, coarctation aorta, patent foramen ovale and moderate tricuspid regurgitation. The patient was given 60mg of oral ibuprofen for the first day and 30mg of oral ibuprofen for the second and third days. In addition, the patient was given 2mg of furosemide, 2.5mg of spironolactone and 12.5mcg of digoxin twice daily to prevent heart failure. Echocardiographic evaluation after three days showed closure of large patent ductus arteriosus, no mild preductal coarctation aorta remains, trivial tricuspid and patent foramen ovale. No side effects were observed. Conclusion: This case showed successful early treatment of large PDA in full-term infants with a double dose of oral ibuprofen. Adverse events were not found. As a result, Ibuprofen should be considered as an early treatment for PDA in full-term infants.