Effect of Pharmacological Closure Therapy on Vital Organ Oxygenation in Premature Infants with Hemodynamically Significant Patent Ductus Arteriosis: Assessment by Near-Infrared Spectroscopy

Effect of Pharmacological Closure Therapy on Vital Organ Oxygenation in Premature Infants with Hemodynamically Significant Patent Ductus Arteriosis: Assessment by Near-Infrared Spectroscopy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effect of Pharmacological Closure Therapy on Vital Organ Oxygenation in Premature Infants with Hemodynamically Significant Patent Ductus Arteriosis: Assessment by Near-Infrared Spectroscopy Murat Konak, Zuleykha ZİYADOVA1, Alaaddin Yorulmaz, Melih Doğan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7408735/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hemodynamically significant patent ductus arteriosus (hsPDA) is a frequent problem in preterm infants and may impair systemic and organ-specific oxygenation. Near-infrared spectroscopy (NIRS) provides a noninvasive tool to evaluate regional tissue oxygenation. Our aim was to investigate the effects of pharmacological closure therapy on cerebral, renal, and mesenteric tissue oxygenation in preterm infants diagnosed with hsPDA. Methods: This prospective observational study was conducted in a tertiary neonatal intensive care unit between September 2021 and November 2024. Twenty-four preterm infants (24–34 weeks gestational age) with hsPDA confirmed by echocardiography were enrolled. Patients received either ibuprofen or paracetamol based on contraindications. Regional tissue oxygen saturation (rSpO₂) and fractional tissue oxygen extraction (FTOE) were monitored continuously using NIRS for 72 hours before and after treatment. Echocardiographic and hemodynamic parameters were also recorded. Results: Ductus closure was achieved in 46% of cases and significant narrowing in 29%. Ibuprofen treatment resulted in a significant reduction in ductal diameter (p=0.002), whereas paracetamol did not (p=0.074). Diastolic and mean blood pressure increased significantly after treatment. Mesenteric rSpO₂ improved significantly at 24–48 hours in the ibuprofen group (p=0.01), while cerebral and renal oxygenation remained unchanged. Conclusion: Pharmacological therapy, particularly ibuprofen, improved hemodynamic stability and mesenteric oxygenation in preterm infants with hsPDA. Mesenteric rSpO₂ may serve as a more sensitive marker of treatment response than cerebral or renal oxygenation. Larger multicenter studies are warranted to confirm these findings. Health sciences/Medical research/Outcomes research Health sciences/Diseases/Cardiovascular diseases/Vascular diseases Hemodynamically Significant PDA (hsPDA) Preterm Infants Near-Infrared Spectroscopy (NIRS) Regional Tissue Oxygenation Mesenteric Oxygenation Cerebral Oxygenation Renal Oxygenation INTRODUCTION Patent ductus arteriosus (PDA) is a permanent opening between the aorta and the pulmonary artery due to physiologic failure of the ductus arteriosus to close after birth. This opening may cause oxygenated blood to escape from the aorta back into the pulmonary artery, leading to increased hemodynamic load on the heart and lungs. This condition, which is especially common in premature infants, may lead to complications such as respiratory distress, pulmonary hypertension and cardiac failure 1 , 2 . In the absence of spontaneous closure, if it disrupts the patient's hemodynamic balance and end-organ perfusion (hemodynamically significant PDA), it should be closed with medication, and if no response is obtained to medical treatment, it should be closed with surgical treatment. Hemodynamically significant PDA (hsPDA) is associated with a significant left-to-right shunt through the ductus and may result in impaired cerebral, renal or mesenteric perfusion. It leads to complications including respiratory failure and bronchopulmonary dysplasia, increased risk of intracranial hemorrhage, necrotizing enterocolitis, renal failure, and overall mortality 3 . Therefore, timely diagnosis and treatment of hsPDA is an important issue. Functional closure usually occurs within the first 72 hours after birth. In preterm infants, high levels of prostaglandins may delay the closure of the ductus. Drug closure therapy has emerged as a common approach to the management of PDA. This treatment is usually carried out using nonsteroidal anti-inflammatory drugs. Ibuprofen, paracetamol and indomethacin are often the drugs of choice for closing the PDA. These drugs help to close the ductus arteriosus by inhibiting the synthesis of prostaglandins 4 , 5 . Neonatal echocardiography is the gold standard for the diagnosis of PDA and evaluation of the hemodynamic impact on the circulation of the premature infant and monitoring the therapeutic response 6 . Echocardiography is a valuable tool for the evaluation of intracardiac changes related to PDA (e.g., DA size, shunt direction, left ventricular and left atrial loading, Doppler flow pattern along the DA, LA/Ao ratio, postductal aortic blood flow pattern, etc.). However, it provides less information about regional blood flow changes in specific organs due to PDA 7 , 8 . Circulatory and/or oxygenation failure in vital organs actually reflects the clinical significance of PDA. Near-infrared spectroscopy (NIRS), one of the noninvasive tools widely used in neonatal intensive care clinical practice, allows continuous assessment of regional oxygenation (rSpO2) and perfusion changes in different organs (brain, kidney, liver, intestines) and may help to reach an appropriate clinical decision on PDA treatment 9 . Although there are many clinical studies on peripheral perfusion, studies on regional oxygenation of the most vulnerable organs in premature newborns with hsPDA are limited. Therefore, in this study, we aimed to evaluate tissue oxygenation by NIRS monitoring of vital organs (cerebral, renal and mesentery) before and after medical treatment in premature infants diagnosed with hsPDA. MATERIALS AND METHODS 1. Study population An observational longitudinal prospective study was conducted in the 3rd level Neonatal Intensive Care Unit (NICU) of Selçuk University Faculty of Medicine Hospital between September 2021 and November 2024. It was approved by the local ethics committee of Selçuk University Faculty of Medicine (2023/463). Informed consent was obtained from the parents before inclusion in the study. Premature newborns born between 24–34 weeks with hemodynamically diagnosed patent ductus arteriosus (hsPDA) were included in the study. The diagnosis of PDA was made by ECHO examination by a pediatric cardiologist after 72 hours. Patients with hemodynamically insignificant PDA who did not receive medical treatment and underwent surgical ligation, late premature infants (over 34 weeks), infants with acute and chronic renal failure, infants born with anomalies, infants with genetic diseases, persistent pulmonary hypertension and patients diagnosed with sepsis were excluded from the study. 2. Drug administration protocol of infants diagnosed with hsPDA Drug treatment was initiated in infants with hemodynamically significant PDA. The patients were divided into two groups as those receiving paracetamol (acetaminophen) and those receiving ibuprofen. These two groups were selected by random sampling. Known contraindications to standard ibuprofen therapy for PDA closure were considered. These included recent (< 48 hours) intraventricular hemorrhage, bleeding diathesis, platelets ≤ 50.000/mm3, pulmonary hemorrhage, necrotizing enterocolitis (NEC), oliguria (basal diuresis 14 mmol/l and/or creatinine > 140 µmol/L) and hyperbilirubinemia with associated risk factors. In the absence of contraindications, patients received oral ibuprofen. The standard dose of ibuprofen for medical closure of the PDA was 10 mg/kg at the first dose, followed by 5 mg/kg every 12 to 24 hours for 3 days, for a total of 3 doses (intravenous or oral administration). Patients with contraindications to standard ibuprofen treatment were treated with paracetamol. Paracetamol (acetaminophen) was administered as standard, 15 mg/kg (IV or oral) every 6 hours for 7 days. 3. Data collection Clinical characteristics such as gestational age, birth weight, gender, multiple pregnancy, mode of delivery, prenatal steroid treatment, mechanical ventilation at the beginning of treatment, FIO2 during treatment, and the day PDA treatment was started were collected from all patients. In addition, arterial blood gas, echocardiography (ECHO) findings (ejection fraction (EF), fractional beats (FS)), systolic and diastolic blood pressure and oxygen saturation (SpO2) values were recorded before and after treatment. According to the clinical protocol applied in the NICU, the diagnosis of hsPDA requiring treatment was made by echocardiography performed with the VIVID device and Philips EPIQ 7C (USA) TTE device. All echocardiographic examinations were performed by two different pediatric cardiologists in the supine position with orthogonal, parasternal and apical views. Ductus arteriosus evaluation was performed with color Doppler from the high parasternal view and its diameter was measured at the narrowest point. LA/Ao ratio was determined using M-mode on the parasternal long axis view. ECHO evaluation was performed when a left-right shunt was demonstrated, the left atrium/aortic root (LA/Ao) ratio was ≥ 1.4, and the diameter of the DA was > 2 mm. Arterial blood pressure was measured noninvasively in the right arm using a PHILIPS MP40 neonatal blood pressure monitor. The mean of three or two measurements was recorded. Appropriate cuff sizes were selected according to manufacturer recommendations to ensure consistency in measurements. All measurements were performed only during routine care, in accordance with minimal intervention guidelines, while the infant was quiet and resting. NIRS (INVOS 5100 C Cerebral/Somatic Oximeter (Medtronic)) device was used for regional tissue oxygenation measurements in all patients during the treatment process. Neonatal/pediatric sensors (SenSmart 8004CB-NA non-adhesive probes with EQUANOXTM technology) were used. Patients were connected to 4 NIRS probes (cerebral, abdominal, right kidney, left kidney) for the first 72 hours of treatment. Recording started 1 hour before the treatment and was recorded for 72 hours during the treatment period. Data from the NIRS device were recorded. For cerebral oxygenation measurement, the sensor was placed in the area between the top of the eyebrow and the hairline, near the midline; for renal oxygenation measurement, the sensor was placed in the left or right posterior lateral region, above the iliac crest and below the lower border of the ribs and fixed with tape. To avoid skin bruising or irritation, the sensor was repositioned every 3 hours by shifting slightly to the center or side. All NIRS data were recorded 1 hour before treatment (T0) and 24 hours after the start of the first dose of drug infusion (T1), 24–48 hours later (T3) and 48–72 hours later (T3). At the same time, SpO2 was measured to calculate fractionated tissue oxygen extraction (FTOE), which reflects the balance between tissue oxygen delivery and tissue oxygen consumption and indirectly reflects tissue perfusion 10 . FTOE was calculated with the following formula: FOE=(SpO₂-rSO₂)/SpO₂. The target range of oxygen saturation was 89–95%, achieved with a minimum FiO₂, and the lower/upper alarm limits were set to 88% and 96%, respectively. 4. Statistical Analysis All statistical analyses were performed using SPSS 23.0 package. Categorical data were summarized with frequency tables and quantitative data with mean ± standard deviation. The difference between the two groups in terms of numerical variables was investigated by Student T test and Mann-Whithney U test. In repeated measurements of more than two groups, repeated measures ANOVA test was applied if the groups were normally distributed, and Friedman test was applied if the groups were not normally distributed. Bonferroni correction was made in comparisons. The significance level was determined as p < 0.05. RESULTS The study included 24 patients who were diagnosed with hsPDA and started drug treatment in the 3rd level Neonatal Intensive Care Unit (NICU) of Selçuk University Faculty of Medicine. Paracetamol and ibuprofen were administered as monotherapy for closure therapy. Ibuprofen was administered in 15 (62.5%) and paracetamol in 9 (37.5%) patients. While 5 (55%) of the patients in the paracetamol group were male and 4 (45%) were female, 9 (60%) of the patients in the ibuprofen group were male and 6 (40%) were female. There was no statistically significant difference between the two groups treated with paracetamol and ibuprofen in terms of gender (p:0.831). Demographic and clinical characteristics of the patients who participated in the study are shown in Table 1 . Table 1 Demographic and clinical characteristics of patients participating in the study Paracetamol group n (%) Ibuprofen group n (%) Total n (%) p Gender n (%) Male 5 (35.7) 9 (64.3) 14 (58.3) 0.831 Female 4 (40.0) 6 (60.0) 10 (41.7) Mode of delivery (%) NYV 1 (20.0) 4 (80.0) 5 (20.8) 0.364 C/S 8 (42.1) 11 (57.9) 19 (79.2) Antenatal steroid Did not receive 4 (36.4) 7 (63.6) 11 (45.8) 0.916 Received 5 (38.5) 8 (61.5) 13 (54.2) Oxygen Type Free O2 1 (50.0) 1 (50.0) 2 (8.3) 0.486 BCPAP 2 (22.2) 7 (77.8) 9 (37.5) Mechanical Ventilation 6 (46.2) 7 (53.8) 13 (54.2) Red Blood Cell Suspension Not Received 3 (33.3) 6 (66.7) 9 (37.5) 0.744 Received 6 (40.0) 9 (60.0) 15 (62.5) Treatment Outcome Closure Narrowing Insufficiency 3 (27.3) 3 (42.8) 3 (50.0) 8 (72.7) 4 (57.2) 3 (50.0) 11 (45.8) 7 (29.2) 6 (25.0) 0.614 Total 9 (37.5) 15 (62.5) 24 (100.0) Mean ± SD Mean ± SD Mean ± SD Birth Week 28.0 ± 3.40 28.1 ± 3.5 28.0 ± 3.4 0.963 Weight 1183.3 ± 570.5 1214.7 ± 486 1202.9 ± 507.2 0.892 Mother's age 29.3 ± 6.1 27.4 ± 6.5 28.1 ± 6.3 0.474 Treatment Duration 7.4 ± 2.9 7.6 ± 4.4 7.5 ± 3.8 0.917 NYVD: normal vaginal delivery, C/S: cesarean section The mean gestational age was 23–34 (mean 28) weeks and the mean birth weight was 1202 g (min-max: 500–2300 g). According to birth weight, 10 patients (41%) were extremely low birth weight (IDBW), 7 patients (29%) were very low birth weight (VLBW), 6 patients (25%) were low birth weight (LBW) and 1 patient (4%) was normal birth weight. Maternal age ranged between 17–40 years (mean 28 years 11 months). After treatment, the ductus arteriosus (DA) was closed in 11 (45.8%) patients and narrowed in 7 (29.2%) patients. Insufficiency persisted in 6 patients (25.0%). The mean DA diameter was 3.24 ± 0.7 mm before treatment and 1.63 ± 1.5 mm after treatment. There was a statistically significant difference in DA diameter before and after treatment (p < 0.001). The comparison of vital and echocardiographic findings of the patients before and after treatment is shown in Table 2 . There was a statistically significant increase in diastolic BP and mean BP values after treatment. Table 2 Comparison of vital and echocardiographic findings of patients participating in the study before and after treatment Before Treatment Post-treatment Mean ± SD Median (Min-max) Mean ± SD Median (Min-max) p DA Diameter (cm) 3.24 ± 0.7 3.2 (0.8 -3) 1.633 ± 1.5 1.7 (1.5–1.8) < 0.001 EF 73.10 ± 7.4 73.1 (7.4–73) 72.215 ± 4.6 72.2 (4.7–71) 0.559 FS 39.0 ± 5.9 39 (6–38.5) 39.0 ± 3.7 39 (3.7–40) 0.831 LA/Ao Ratio 1.63 ± 0.4 1.6 (0.4–1.8) 1.92 ± 0.2 1.9 (0.2–1.8) 0.674 Systolic BP, mm Hg 66.13 ± 10.38 65.25 (41.50–83.0) 68.16 ± 7.40 70.20 (49.10–79.30) 0.640 Diastolic BP, mm Hg 37.72 ± 9.75 37.75 (19.50–54.50 41.85 ± 7.31 44.85 (27.40–54.50) < 0.001 Mean BP, mm Hg 42.72 ± 7.17 38.00 (38.00–62.00) 52.80 ± 10.62 53.30 (32.60–72.50) < 0.001 DA: Ductus Arteriosus, EF: Ejection Fraction, FS: Fractional Shortening, LA/Ao ratio: Left atrium to aortic root, BP: Blood Pressure. The mean DA value of the patients in the paracetamol group was 3.2 ± 0.6 mm before treatment and 2.3 ± 1.3 mm after treatment and there was no statistically significant difference between the two (p:0.074). The mean DA value of the patients in the ibubrufen group was 3.2 ± 0.8 mm before treatment and 1.57 ± 1.6 mm after treatment, and a statistically significant difference was found between the two (p:0.002). The comparison of clinical and echocardiographic measurements of the patients in the paracetamol and ibuprofen groups before and after treatment is shown in Table 3 . In addition, when diastolic BP and mean BP values were analyzed, a statistically significant difference was found between the paracetamol and ibuprofen groups before and after treatment. EF, FS, LA/Ao ratio and systolic BP values of the patients were not statistically significantly different between paracetamol and ibubrufen groups before and after treatment. Table 3 Comparison of pre- and post-treatment clinical and echocardiographic measurements in patients in the paracetamol and ibuprofen groups Paracetamol group Ibuprofen group Treatment time Mean ± SD Median (min-max) p Mean ± SD Median (min-max) p SBP (mmHg) Before 67 ± 10 65.5 (52–83) 0.130 65.6 ± 10 65 (41–80) 0.270 Post 70.5 ± 10.6 73.3 (52–89) 66.84 ± 10.6 68.5 (46–85) DBP (mmHg) Before 36.2 ± 8.6 34 (24–46.5) 0.009 38.6 ± 10 38.5 (19–54) 0.025 Post 43 ± 9.6 40 (32–60) 42.3 ± 11.1 42 (26–64) Mean BP (mmHg) Before 45.1 ± 9 43.5 (32–59) 0.009 47 ± 10 47 (29–63) 0.037 After 52 ± 9 50 (41–70) 53 ± 11 54 (32–72) EF Before 77 ± 4.8 76 (70–83) 0.123 70.86 ± 7.8 68 (60–84) 0.440 After 72.2 ± 6.1 71 (64–82) 72.6 ± 5.39 70 (60–82) FS Before 42.1 ± 4.3 40 (37–49) 0.176 37 ± 6.1 35 (29–48) 0.400 After 38.5 ± 4.7 37 (32–46) 38.5 ± 3.7 39 (30–43) LA/Ao Ratio Before 1.63 ± 0.40 1.83 (1.14–2.0) 0.180 1.63 ± 0.45 1.80 (0.60–2.14) 0.715 After 2.15 ± 0.14 2.15 (2.14–2.16) 1.84 ± 0.10 1.83 (1.71–2.0) DA diameter (mm) Before 3.2 ± 0.6 3.0 (2–4) 0.074 3.2 ± 0.8 3.0 (2–5) 0.002 After 2.3 ± 1.3 2.0 (0–4) 1.57 ± 1.6 1.0 (0–5) SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure DA: Ductus Arteriosus, EF: Ejection Fraction, FS: Fractional Shortening, LA/Ao ratio: Left atrium to aortic root, BP: Blood Pressure. There was a statistically significant difference between the mesenteric rSpo 2 measurement values obtained at four different times (p:0,018). The mean value obtained at T1 was 60.33, while the mean values obtained at T2,T3 and T4 were 62.22, 63.43 and 63.32, respectively. The measurement value obtained at time T1 was lower than the values obtained at other times and there was a statistically significant difference. There was also a statistically significant difference in diastolic BP, mean BP, values obtained at 4 different times. When we compared all patients according to different time intervals, there was no statistically significant difference in cerebral rSpO 2 , cerebral FTOE and SpO 2 , intestinal FTOE, right and left rSpO 2 and FTOE values. Comparison of rSpO 2 , FTOE and SpO 2 measurements at different time points is shown in Table 4 . Table 4 Comparison of rSpO 2 , SpO (2), and FTOE measurements at different time points T0 T1 T2 T3 Mean ± SD Mean ± SD Mean ± SD Mean ± SD p Systolic BP, mm Hg 66.14 ± 10.39 66.23 ± 10.48 69.47 ± 8.2 68.76 ± 8.27 0.164 Diastolic BP, mm Hg 37.73 ± 9.76 a 39.88 ± 8.3 a 42.5 ± 8.76 a 43.19 ± 8.13 b 0.006 Mean BP, mm Hg 42.73 ± 7.17 a 46.95 ± 5.71 b 51.2 ± 7.51 c 51.17 ± 8.23 c < 0.001 Brain rSpO ₂ 72.67 ± 6.82 72.1 ± 6.17 73.31 ± 5.46 70.2 ± 5.65 0.131 Mesenteric rSpO₂ 60.33 ± 5.78 a 62.22 ± 5.95 b 63.43 ± 7.29 b 63.32 ± 7.05 b 0.018 Right Kidney rSpO 2 69.58 ± 10.18 68.2 ± 7.81 67.99 ± 7.15 68.18 ± 8.15 0.728 Left Kidney rSpO 2 69.79 ± 8.19 70.42 ± 6.96 68.38 ± 6.99 68.24 ± 7.41 0.457 SpO 2 94.58 ± 2.58 94.48 ± 1.86 93.74 ± 1.64 93.92 ± 1.99 0.162 Brain FTOE 0.23 ± 0.07 0.24 ± 0.08 0.22 ± 0.06 0.25 ± 0.06 0.201 Intestinal FTOE 0.36 ± 0.09 0.34 ± 0.06 0.32 ± 0.08 0.33 ± 0.07 0.104 Right Kidney FTOE 0.26 ± 0.10 0.28 ± 0.08 0.27 ± 0.07 0.27 ± 0.08 0.613 Left Kidney FTOE 0.25 ± 0.08 0.26 ± 0.07 0.27 ± 0.07 0.27 ± 0.08 0.358 rSpO₂ : Regional tissue oxygenation , SpO₂ : oxygen saturation, FTOE: Fractional Tissue Oxygen Extraction. a−c : No significant difference between time points with the same letter There was no statistically significant difference in rSpO₂, FOE and SpO₂ values in tissues according to different time intervals in the paracetamol group (p > 0.05). However, the mesenteric rSpO₂ values of the patients in the ibuprofen group were found to be significantly higher at T2 time compared to the baseline value of T0 (p:0.01). Mesenteric FOE values at T2 time were lower than T0; however, this difference was not statistically significant (p:0,700). The comparison of rSpPO2, SPO2 and FTOE values according to different time intervals in paracetamol and ibuprofen group patients is shown in Table 5 . Table 5 Comparison of rSpPO2, SPO2, and FTOE values in patients in the paracetamol and ibuprofen groups at different time intervals Paracetamol Group Ibuprofen Group Parameter T0 T1 T2 T3 p T0 T1 T2 T3 p Brain rSO2 (%) 73.22 72.72 73.77 70.13 0.200 72.33 71.72 73.02 70.23 0.340 Mesenteric rSO2 (%) 61.78 61.65 63.64 61.89 0.860 59.47 62.55 63.29 64.17 < 0.001 Right Kidney rSO2 (%) 68.56 68.1 68.16 65.17 0.26 70.2 68.25 67.88 69.98 0.450 Left Kidney rSO2 (%) 71.3 68.74 68.6 66.8 0.33 68.87 71.42 68.24 69.11 0.058 SpO2 (%) 93.83 94.06 93.07 93.34 0.500 95.03 94.72 94.14 94.26 0.890 Brain FTOE (%) 0.21 0.22 0.2 0.24 0.530 0.23 0.24 0.22 0.25 0.450 Mesenteric FTOE (%) 0.34 0.34 0.31 0.33 0.70 0.37 0.33 0.32 0.31 0.120 Right Kidney FTOE (%) 0.26 0.27 0.26 0 0.51 0.26 0.27 0.27 0.25 0.620 Left Kidney FTOE (%) 0.24 0.26 0.26 0.28 0.32 0.27 0.24 0.27 0.26 0.056 rSpO 2 : Regional tissue oxygenation, SpO 2 : oxygen saturation, FTOE: Fractional Tissue Oxygen Extraction. DISCUSSION This study was conducted to evaluate the efficacy of paracetamol and ibuprofen in the treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in premature infants. Our findings show that both drugs are effective in the treatment of PDA, but the effects of paracetamol and ibuprofen on hemodynamic parameters and organ oxygenation may differ from each other. In the study by Navikiene et al. a significant decrease in PDA diameters was found after paracetamol and ibuprofen treatment in patients with hsPDA 11 . Similarly, in our study, a statistically significant reduction in PDA diameters was observed after treatment, especially in the ibuprofen-treated patient group. However, numerous systematic reviews and meta-analyses have revealed that the efficacy of paracetamol and ibuprofen on PDA closure is similar 12 , 13 . As known, late initiation of medical treatment for symptomatic PDA is less effective than early (targeted or prophylactic) treatment, but it reduces the diameter of the ductus and decreases the need for surgical ligation 14 . Indeed, El-Khuffash et al. reported that late intravenous paracetamol administration was associated with only 25% successful ductus closure, but significantly reduced the need for surgical treatment for PDA 15 . In our study, complete closure was found in eleven patients and a significant decrease in duct diameter was found in 13 patients after medical treatment. However, no significant change was found in the LA/Ao ratio. Another prominent finding in our study was a statistically significant increase in diastolic and mean blood pressure values after treatment in the ibuprofen group. As stated by Rios et al., hsPDA may be associated with circulatory disturbance and hypotension, and medical treatment may stabilize both systemic blood flow and blood pressure 16 , 17 . Similarly, some other studies have reported that medical treatment initiated in the presence of PDA may contribute to an increase in blood pressure 11 , 17 . HsPDA is known to affect regional tissue oxygenation and circulation in the brain and kidneys, which are vital organs 5 , 18 . In this study, we hypothesized that medical treatment may improve oxygenation at the organ level by reducing hemodynamic disturbances due to PDA and that these improvements may be used in the evaluation of treatment efficacy and clinical follow-up processes. According to our findings, a statistically significant increase in mesenteric rSpO₂ values and a decreasing trend in mesenteric FOE were observed in patients receiving ibuprofen. In contrast, there was no statistically significant change in brain tissue oxygenation and right and left kidney tissue oxygenation after treatment. Some clinical studies have shown that renal tissue oxygenation is affected earlier and more markedly in the presence of hsPDA compared to brain tissue oxygenation 19 , 20 . This finding suggests that closure of the PDA may primarily affect postductal circulation and oxygenation. In addition, it is known that shunt flow usually occurs in the direction affecting the lower body circulation (postductal region) 21 . While brain tissue oxygenation is affected by preductal systemic perfusion, renal oxygenation is more sensitive to diastolic leakage in the postductal region 22 . Similarly, in our study, it was found that shunt flow due to hsPDA affected the postductal region more prominently and a statistically significant increase occurred especially in mesenteric tissue oxygenation after medical treatment. In contrast to our study, some studies have reported an increase in cerebral SpO₂ and a decrease in FOE following PDA closure 23 , 24 . In some studies, only an increase in FOE was found 10 . Navikiene et al. found a significant increase in renal rSpO₂ and a decrease in FOE after hsPDA treatment, but did not observe a significant change in cerebral tissue oxygenation 11 . Dani et al. also found no significant difference in cerebral oxygenation in patients treated with paracetamol and ibuprofen 25 . In our study, a statistically significant increase was found in mesenteric tissue oxygenation in infants treated with ibuprofen for hsPDA, whereas no significant change was found in brain and renal tissue oxygenation. It is thought that this may be explained by the presence of a mechanism of cerebral autoregulation, which means that cerebral blood flow may be kept constant despite blood pressure fluctuations 26 . It is thought that differences in the age, body weight, PDA diameter, time of initiation of treatment, and the drugs and dosages used in the infants may cause these inconsistencies between the studies. In our study, considering that the ductus was not completely closed in most cases, but only narrowed, the fact that no significant change was found in cerebral and renal rSpO₂ and FTOE may be a possible explanation for this situation. However, it has been shown that only narrowing of the ductus leads to favorable changes in mesenteric tissue oxygenation and circulation that can be detected by NIRS. The findings suggest that mesenteric tissue rSpO₂ may be a more sensitive indicator in assessing hsPDA treatment response compared to cerebral and renal rSpO₂. NIRS application times vary widely in the literature: In most of the studies, the measurement period was kept shorter than 1 hour, while only a few studies (Chock, Arman, Poon) followed up for 24 hours or longer 20 , 23 , 24 . One of the strengths of our study compared to other studies is that the NIRS application period covers a longer follow-up period of 72 hours. The fact that most of the studies in this field have been conducted with small sample sizes can be considered as one of the main reasons for the inconsistencies in the literature. Similarly, an important limitation of our study is the relatively small number of patients. In conclusion, our study demonstrated that ibuprofen treatment contributed to hemodynamic balance by increasing diastolic and mean blood pressure in premature infants with hsPDA, and especially significantly improved mesenteric tissue oxygenation. In contrast, no significant change was found in cerebral and renal tissue oxygenation, which may be related to the effect of cerebral autoregulation or incomplete closure of the ductus. Mesenteric tissue oxygenation may be a more sensitive indicator for monitoring treatment response. Larger sample, multicenter and long-term follow-up studies are required to confirm our findings. Declarations Funding Source: No funding was secured for this study Financial Disclosure: All authors have no financial relationships relevant to this article to disclose. Conflict of Interest: All authors have no conflicts of interest to disclose AUTHORS’ CONTRIBUTIONS Z.Z. performed the study design, data collection, statistical analyses, drafted the initial manuscript, and revised the manuscript. M.K. made substantial contributions to the study design and interpretation of data and revised the manuscript. A.Y. provided supervision throughout the entire process and made substantial contributions to the study design, interpretation of data and revision of the manuscript. M.T.D. performed the study design, data collection, statistical analyses S.S.U. made substantial contributions to the study design H.S. provided supervision throughout the entire process and made substantial contributions to the study design, interpretation of data and revision of the manuscript. All authors have read the draft and approved the final manuscript as submitted. References Sadler TW. Langman's Medical Embryology. Plastic and Reconstructive Surgery . 1988;81(1):131. Moore KL, Persaud TV, Torchia MG. Embryologie: Entwicklungsstadien, Frühentwicklung, Organogenese, Klinik . Elsevier, Urban & Fischer; 2013. Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics . May 2010;125(5):1020–30. doi: 10.1542/peds.2009-3506 Conrad C, Newberry D. Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population. Adv Neonatal Care . Jun 2019;19(3):179–187. doi: 10.1097/ANC.0000000000000590 Lemmers PM, Toet MC, van Bel F. Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants. Pediatrics . Jan 2008;121(1):142–7. doi: 10.1542/peds.2007-0925 De Boode W, Kluckow M, McNamara P, Gupta S. Role of neonatologist-performed echocardiography in the assessment and management of patent ductus arteriosus physiology in the newborn. Elsevier; 2018:292–297. Arlettaz R. Echocardiographic evaluation of patent ductus arteriosus in preterm infants. Frontiers in pediatrics . 2017;5:147. Singh Y, Fraisse A, Erdeve O, Atasay B. Echocardiographic diagnosis and hemodynamic evaluation of patent ductus arteriosus in extremely low gestational age newborn (ELGAN) infants. Frontiers in pediatrics . 2020;8:573627. Gorman KM, Pinnamaneni RM, Franklin O, Foran A. Effects of ibuprofen on cerebral and somatic regional tissue oxygenation, using near-infrared spectroscopy in preterm infants < 1500g with a patent ductus arteriosus. Journal of Clinical Neonatology . 2015;4(3):178–182. Schwarz CE, Preusche A, Wolf M, Poets CF, Franz AR. Prospective observational study on assessing the hemodynamic relevance of patent ductus arteriosus with frequency domain near-infrared spectroscopy. BMC pediatrics . 2018;18(1):66. Navikienė J, Liubšys A, Viršilas E, Žvirblis T, Jankauskienė A. Impact of medical treatment of hemodynamically significant patent ductus arteriosus on cerebral and renal tissue oxygenation measured by near-infrared spectroscopy in very low-birth-weight infants. Medicina . 2022;58(4):475. Huang X, Wang F, Wang K. Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials. The Journal of Maternal-Fetal & Neonatal Medicine . 2018;31(16):2216–2222. Ohlsson A, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants. Cochrane Database of Systematic Reviews . 2018;(4) Mashally S, Banihani R, Jasani B, et al. Is late treatment with acetaminophen safe and effective in avoiding surgical ligation among extremely preterm neonates with persistent patent ductus arteriosus? Journal of Perinatology . 2021;41(10):2519–2525. Afif E-K, James AT, Cleary A, Semberova J, Franklin O, Miletin J. Late medical therapy of patent ductus arteriosus using intravenous paracetamol. Archives of Disease in Childhood-Fetal and Neonatal Edition . 2015;100(3):F253-F256. Rios DR, Bhattacharya S, Levy PT, McNamara PJ. Circulatory insufficiency and hypotension related to the ductus arteriosus in neonates. Frontiers in pediatrics . 2018;6:62. Han UJ, Cho HJ, Cho YK, Choi YY, Ma JS. Change in blood pressure and pulse pressure in preterm infants after treatment of patent ductus arteriosus with indomethacin. Korean circulation journal . 2011;41(4):203–208. Petrova A, Bhatt M, Mehta R. Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus. Journal of Perinatology . 2011;31(7):460–464. Navikiene J, Virsilas E, Vankeviciene R, Liubsys A, Jankauskiene A. Brain and renal oxygenation measured by NIRS related to patent ductus arteriosus in preterm infants: a prospective observational study. BMC pediatrics . 2021;21(1):559. Chock VY, Rose LA, Mante JV, Punn R. Near-infrared spectroscopy for detection of a significant patent ductus arteriosus. Pediatric Research . 2016;80(5):675–680. Broadhouse KM, Price AN, Durighel G, et al. Assessment of PDA shunt and systemic blood flow in newborns using cardiac MRI. NMR in Biomedicine . 2013;26(9):1135–1141. Altit G, Bhombal S, Chock VY. End-organ saturations correlate with aortic blood flow estimates by echocardiography in the extremely premature newborn–an observational cohort study. BMC pediatrics . 2021;21(1):312. Arman D, Sancak S, Gürsoy T, Topcuoğlu S, Karatekin G, Ovalı F. The association between NIRS and Doppler ultrasonography in preterm infants with patent ductus arteriosus. The Journal of Maternal-Fetal & Neonatal Medicine . 2020;33(7):1245–1252. Poon WB, Tagamolila V. Cerebral perfusion and assessing hemodynamic significance for patent ductus arteriosus using near infrared red spectroscopy in very low birth weight infants. The Journal of Maternal-Fetal & Neonatal Medicine . 2021;34(10):1645–1650. Dani C, Poggi C, Cianchi I, Corsini I, Vangi V, Pratesi S. Effect on cerebral oxygenation of paracetamol for patent ductus arteriosus in preterm infants. European journal of pediatrics . 2018;177(4):533–539. Tsuji M, Saul JP, Du Plessis A, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics . 2000;106(4):625–632. Additional Declarations There is NO conflict of interest to disclose. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7408735","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":503866928,"identity":"755cc1c9-696f-4616-b4c1-d91d436af3d5","order_by":0,"name":"Murat Konak","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYDCCAwzMIMqAXwLMlZAhXovkDAbGBqAWHuK1GNwAa2EgrIXv9ulkg4877IyNbzcff3SjxoKHgf3w0Q34tEiey92cOPNMspnZnWOJzTnHgA7jSUu7gU+LwRnezYd525htzG7kGDbnsAG1SPCYEaOl3sZ4BkjLPyK1JPO2HTYzkABqyW0jQoskUIvhzLbjxhI30hJn5/ZJ8LAR8gsfUIvEx7Zqw/4ZyQc+53yrk+NnP3wMrxZMwEaa8lEwCkbBKBgF2AAARuJHeG+mvPkAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-8728-4541","institution":"Selcuk University,","correspondingAuthor":true,"prefix":"","firstName":"Murat","middleName":"","lastName":"Konak","suffix":""},{"id":503866929,"identity":"39105b07-b79f-4ebb-986e-565118c42cef","order_by":1,"name":"Zuleykha ZİYADOVA1","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Zuleykha","middleName":"","lastName":"ZİYADOVA1","suffix":""},{"id":503866930,"identity":"fc8ceda4-1a3c-46c9-96b5-2ace3af36444","order_by":2,"name":"Alaaddin Yorulmaz","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Alaaddin","middleName":"","lastName":"Yorulmaz","suffix":""},{"id":503866931,"identity":"8afc215f-179c-4e42-849a-3ff73b440a3d","order_by":3,"name":"Melih Doğan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Melih","middleName":"","lastName":"Doğan","suffix":""},{"id":503866932,"identity":"dc9d94d1-10a3-48bf-8952-c76bd0e1494f","order_by":4,"name":"Saime Sündüs Uygun","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Saime","middleName":"Sündüs","lastName":"Uygun","suffix":""},{"id":503866933,"identity":"a108a522-30f5-40fa-8eac-43f236b09995","order_by":5,"name":"Hanifi Soylu","email":"","orcid":"","institution":"University of Manitoba","correspondingAuthor":false,"prefix":"","firstName":"Hanifi","middleName":"","lastName":"Soylu","suffix":""}],"badges":[],"createdAt":"2025-08-19 12:42:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7408735/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7408735/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91419894,"identity":"b0757302-72d4-4bd0-bad3-10ec07f3748e","added_by":"auto","created_at":"2025-09-16 10:03:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1174907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7408735/v1/2a960b68-67af-41d9-b492-c390683d0d15.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Effect of Pharmacological Closure Therapy on Vital Organ Oxygenation in Premature Infants with Hemodynamically Significant Patent Ductus Arteriosis: Assessment by Near-Infrared Spectroscopy","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePatent ductus arteriosus (PDA) is a permanent opening between the aorta and the pulmonary artery due to physiologic failure of the ductus arteriosus to close after birth. This opening may cause oxygenated blood to escape from the aorta back into the pulmonary artery, leading to increased hemodynamic load on the heart and lungs. This condition, which is especially common in premature infants, may lead to complications such as respiratory distress, pulmonary hypertension and cardiac failure\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. In the absence of spontaneous closure, if it disrupts the patient's hemodynamic balance and end-organ perfusion (hemodynamically significant PDA), it should be closed with medication, and if no response is obtained to medical treatment, it should be closed with surgical treatment. Hemodynamically significant PDA (hsPDA) is associated with a significant left-to-right shunt through the ductus and may result in impaired cerebral, renal or mesenteric perfusion. It leads to complications including respiratory failure and bronchopulmonary dysplasia, increased risk of intracranial hemorrhage, necrotizing enterocolitis, renal failure, and overall mortality\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Therefore, timely diagnosis and treatment of hsPDA is an important issue.\u003c/p\u003e\u003cp\u003eFunctional closure usually occurs within the first 72 hours after birth. In preterm infants, high levels of prostaglandins may delay the closure of the ductus. Drug closure therapy has emerged as a common approach to the management of PDA. This treatment is usually carried out using nonsteroidal anti-inflammatory drugs. Ibuprofen, paracetamol and indomethacin are often the drugs of choice for closing the PDA. These drugs help to close the ductus arteriosus by inhibiting the synthesis of prostaglandins\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eNeonatal echocardiography is the gold standard for the diagnosis of PDA and evaluation of the hemodynamic impact on the circulation of the premature infant and monitoring the therapeutic response\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Echocardiography is a valuable tool for the evaluation of intracardiac changes related to PDA (e.g., DA size, shunt direction, left ventricular and left atrial loading, Doppler flow pattern along the DA, LA/Ao ratio, postductal aortic blood flow pattern, etc.). However, it provides less information about regional blood flow changes in specific organs due to PDA\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Circulatory and/or oxygenation failure in vital organs actually reflects the clinical significance of PDA. Near-infrared spectroscopy (NIRS), one of the noninvasive tools widely used in neonatal intensive care clinical practice, allows continuous assessment of regional oxygenation (rSpO2) and perfusion changes in different organs (brain, kidney, liver, intestines) and may help to reach an appropriate clinical decision on PDA treatment\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAlthough there are many clinical studies on peripheral perfusion, studies on regional oxygenation of the most vulnerable organs in premature newborns with hsPDA are limited. Therefore, in this study, we aimed to evaluate tissue oxygenation by NIRS monitoring of vital organs (cerebral, renal and mesentery) before and after medical treatment in premature infants diagnosed with hsPDA.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cb\u003e1. Study population\u003c/b\u003e\u003c/p\u003e\u003cp\u003e An observational longitudinal prospective study was conducted in the 3rd level Neonatal Intensive Care Unit (NICU) of Sel\u0026ccedil;uk University Faculty of Medicine Hospital between September 2021 and November 2024. It was approved by the local ethics committee of Sel\u0026ccedil;uk University Faculty of Medicine (2023/463). Informed consent was obtained from the parents before inclusion in the study. Premature newborns born between 24\u0026ndash;34 weeks with hemodynamically diagnosed patent ductus arteriosus (hsPDA) were included in the study. The diagnosis of PDA was made by ECHO examination by a pediatric cardiologist after 72 hours. Patients with hemodynamically insignificant PDA who did not receive medical treatment and underwent surgical ligation, late premature infants (over 34 weeks), infants with acute and chronic renal failure, infants born with anomalies, infants with genetic diseases, persistent pulmonary hypertension and patients diagnosed with sepsis were excluded from the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Drug administration protocol of infants diagnosed with hsPDA\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDrug treatment was initiated in infants with hemodynamically significant PDA. The patients were divided into two groups as those receiving paracetamol (acetaminophen) and those receiving ibuprofen. These two groups were selected by random sampling.\u003c/p\u003e\u003cp\u003eKnown contraindications to standard ibuprofen therapy for PDA closure were considered. These included recent (\u0026lt;\u0026thinsp;48 hours) intraventricular hemorrhage, bleeding diathesis, platelets\u0026thinsp;\u0026le;\u0026thinsp;50.000/mm3, pulmonary hemorrhage, necrotizing enterocolitis (NEC), oliguria (basal diuresis\u0026thinsp;\u0026lt;\u0026thinsp;1 ml/kg/h despite adequate hydration), renal impairment (defined as BUN\u0026thinsp;\u0026gt;\u0026thinsp;14 mmol/l and/or creatinine\u0026thinsp;\u0026gt;\u0026thinsp;140 \u0026micro;mol/L) and hyperbilirubinemia with associated risk factors. In the absence of contraindications, patients received oral ibuprofen. The standard dose of ibuprofen for medical closure of the PDA was 10 mg/kg at the first dose, followed by 5 mg/kg every 12 to 24 hours for 3 days, for a total of 3 doses (intravenous or oral administration). Patients with contraindications to standard ibuprofen treatment were treated with paracetamol. Paracetamol (acetaminophen) was administered as standard, 15 mg/kg (IV or oral) every 6 hours for 7 days.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Data collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eClinical characteristics such as gestational age, birth weight, gender, multiple pregnancy, mode of delivery, prenatal steroid treatment, mechanical ventilation at the beginning of treatment, FIO2 during treatment, and the day PDA treatment was started were collected from all patients. In addition, arterial blood gas, echocardiography (ECHO) findings (ejection fraction (EF), fractional beats (FS)), systolic and diastolic blood pressure and oxygen saturation (SpO2) values were recorded before and after treatment.\u003c/p\u003e\u003cp\u003eAccording to the clinical protocol applied in the NICU, the diagnosis of hsPDA requiring treatment was made by echocardiography performed with the VIVID device and Philips EPIQ 7C (USA) TTE device. All echocardiographic examinations were performed by two different pediatric cardiologists in the supine position with orthogonal, parasternal and apical views. Ductus arteriosus evaluation was performed with color Doppler from the high parasternal view and its diameter was measured at the narrowest point. LA/Ao ratio was determined using M-mode on the parasternal long axis view. ECHO evaluation was performed when a left-right shunt was demonstrated, the left atrium/aortic root (LA/Ao) ratio was \u0026ge;\u0026thinsp;1.4, and the diameter of the DA was \u0026gt;\u0026thinsp;2 mm.\u003c/p\u003e\u003cp\u003eArterial blood pressure was measured noninvasively in the right arm using a PHILIPS MP40 neonatal blood pressure monitor. The mean of three or two measurements was recorded. Appropriate cuff sizes were selected according to manufacturer recommendations to ensure consistency in measurements. All measurements were performed only during routine care, in accordance with minimal intervention guidelines, while the infant was quiet and resting.\u003c/p\u003e\u003cp\u003eNIRS (INVOS 5100 C Cerebral/Somatic Oximeter (Medtronic)) device was used for regional tissue oxygenation measurements in all patients during the treatment process. Neonatal/pediatric sensors (SenSmart 8004CB-NA non-adhesive probes with EQUANOXTM technology) were used. Patients were connected to 4 NIRS probes (cerebral, abdominal, right kidney, left kidney) for the first 72 hours of treatment. Recording started 1 hour before the treatment and was recorded for 72 hours during the treatment period. Data from the NIRS device were recorded. For cerebral oxygenation measurement, the sensor was placed in the area between the top of the eyebrow and the hairline, near the midline; for renal oxygenation measurement, the sensor was placed in the left or right posterior lateral region, above the iliac crest and below the lower border of the ribs and fixed with tape. To avoid skin bruising or irritation, the sensor was repositioned every 3 hours by shifting slightly to the center or side. All NIRS data were recorded 1 hour before treatment (T0) and 24 hours after the start of the first dose of drug infusion (T1), 24\u0026ndash;48 hours later (T3) and 48\u0026ndash;72 hours later (T3). At the same time, SpO2 was measured to calculate fractionated tissue oxygen extraction (FTOE), which reflects the balance between tissue oxygen delivery and tissue oxygen consumption and indirectly reflects tissue perfusion\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. FTOE was calculated with the following formula: FOE=(SpO₂-rSO₂)/SpO₂. The target range of oxygen saturation was 89\u0026ndash;95%, achieved with a minimum FiO₂, and the lower/upper alarm limits were set to 88% and 96%, respectively.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4. Statistical Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll statistical analyses were performed using SPSS 23.0 package. Categorical data were summarized with frequency tables and quantitative data with mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The difference between the two groups in terms of numerical variables was investigated by Student T test and Mann-Whithney U test. In repeated measurements of more than two groups, repeated measures ANOVA test was applied if the groups were normally distributed, and Friedman test was applied if the groups were not normally distributed. Bonferroni correction was made in comparisons. The significance level was determined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e The study included 24 patients who were diagnosed with hsPDA and started drug treatment in the 3rd level Neonatal Intensive Care Unit (NICU) of Sel\u0026ccedil;uk University Faculty of Medicine. Paracetamol and ibuprofen were administered as monotherapy for closure therapy. Ibuprofen was administered in 15 (62.5%) and paracetamol in 9 (37.5%) patients. While 5 (55%) of the patients in the paracetamol group were male and 4 (45%) were female, 9 (60%) of the patients in the ibuprofen group were male and 6 (40%) were female. There was no statistically significant difference between the two groups treated with paracetamol and ibuprofen in terms of gender (p:0.831). Demographic and clinical characteristics of the patients who participated in the study are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and clinical characteristics of patients participating in the study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParacetamol group\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIbuprofen group\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGender n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (64.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (41.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMode of delivery (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eNYV\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.364\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eC/S\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (42.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (57.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (79.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAntenatal steroid\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eDid not receive\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (45.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.916\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eReceived\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (54.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOxygen Type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eFree O2\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.486\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBCPAP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (77.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (37.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eMechanical Ventilation\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (54.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eRed Blood Cell Suspension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eNot Received\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.744\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eReceived\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (62.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTreatment Outcome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eClosure\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNarrowing\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eInsufficiency\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (27.3)\u003c/p\u003e\u003cp\u003e3 (42.8)\u003c/p\u003e\u003cp\u003e3 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (72.7)\u003c/p\u003e\u003cp\u003e4 (57.2)\u003c/p\u003e\u003cp\u003e3 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (45.8)\u003c/p\u003e\u003cp\u003e7 (29.2)\u003c/p\u003e\u003cp\u003e6 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.614\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBirth Week\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.963\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1183.3\u0026thinsp;\u0026plusmn;\u0026thinsp;570.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1214.7\u0026thinsp;\u0026plusmn;\u0026thinsp;486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1202.9\u0026thinsp;\u0026plusmn;\u0026thinsp;507.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.892\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother's age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.474\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTreatment Duration\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNYVD: normal vaginal delivery, C/S: cesarean section\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean gestational age was 23\u0026ndash;34 (mean 28) weeks and the mean birth weight was 1202 g (min-max: 500\u0026ndash;2300 g). According to birth weight, 10 patients (41%) were extremely low birth weight (IDBW), 7 patients (29%) were very low birth weight (VLBW), 6 patients (25%) were low birth weight (LBW) and 1 patient (4%) was normal birth weight. Maternal age ranged between 17\u0026ndash;40 years (mean 28 years 11 months).\u003c/p\u003e\u003cp\u003eAfter treatment, the ductus arteriosus (DA) was closed in 11 (45.8%) patients and narrowed in 7 (29.2%) patients. Insufficiency persisted in 6 patients (25.0%). The mean DA diameter was 3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 mm before treatment and 1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 mm after treatment. There was a statistically significant difference in DA diameter before and after treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The comparison of vital and echocardiographic findings of the patients before and after treatment is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There was a statistically significant increase in diastolic BP and mean BP values after treatment.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of vital and echocardiographic findings of patients participating in the study before and after treatment\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBefore Treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePost-treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian (Min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedian (Min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDA Diameter (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.2 (0.8 -3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.633\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.7 (1.5\u0026ndash;1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e73.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.1 (7.4\u0026ndash;73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e72.215\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e72.2 (4.7\u0026ndash;71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.559\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (6\u0026ndash;38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39 (3.7\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLA/Ao Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6 (0.4\u0026ndash;1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.9 (0.2\u0026ndash;1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSystolic BP, mm Hg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e66.13\u0026thinsp;\u0026plusmn;\u0026thinsp;10.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.25 (41.50\u0026ndash;83.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.16\u0026thinsp;\u0026plusmn;\u0026thinsp;7.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e70.20 (49.10\u0026ndash;79.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.640\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiastolic BP, mm Hg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e37.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.75 (19.50\u0026ndash;54.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.85\u0026thinsp;\u0026plusmn;\u0026thinsp;7.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e44.85 (27.40\u0026ndash;54.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean BP, mm Hg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e42.72\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.00 (38.00\u0026ndash;62.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e52.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e53.30 (32.60\u0026ndash;72.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eDA: Ductus Arteriosus, EF: Ejection Fraction, FS: Fractional Shortening, LA/Ao ratio: Left atrium to aortic root, BP: Blood Pressure.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean DA value of the patients in the paracetamol group was 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 mm before treatment and 2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 mm after treatment and there was no statistically significant difference between the two (p:0.074). The mean DA value of the patients in the ibubrufen group was 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 mm before treatment and 1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 mm after treatment, and a statistically significant difference was found between the two (p:0.002). The comparison of clinical and echocardiographic measurements of the patients in the paracetamol and ibuprofen groups before and after treatment is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In addition, when diastolic BP and mean BP values were analyzed, a statistically significant difference was found between the paracetamol and ibuprofen groups before and after treatment. EF, FS, LA/Ao ratio and systolic BP values of the patients were not statistically significantly different between paracetamol and ibubrufen groups before and after treatment.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of pre- and post-treatment clinical and echocardiographic measurements in patients in the paracetamol and ibuprofen groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eParacetamol group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eIbuprofen group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTreatment time\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedian (min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMedian (min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSBP (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBefore\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.5 (52\u0026ndash;83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e65.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65 (41\u0026ndash;80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.270\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003ePost\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.3 (52\u0026ndash;89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e66.84\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e68.5 (46\u0026ndash;85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eDBP (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBefore\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e36.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (24\u0026ndash;46.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e38.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e38.5 (19\u0026ndash;54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003ePost\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (32\u0026ndash;60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42 (26\u0026ndash;64)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMean BP (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBefore\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e45.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.5 (32\u0026ndash;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e47\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47 (29\u0026ndash;63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eAfter\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e52\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50 (41\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e53\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e54 (32\u0026ndash;72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eEF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBefore\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (70\u0026ndash;83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e70.86\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e68 (60\u0026ndash;84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.440\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eAfter\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e72.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (64\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e72.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70 (60\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eFS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBefore\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (37\u0026ndash;49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e35 (29\u0026ndash;48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.400\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eAfter\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (32\u0026ndash;46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39 (30\u0026ndash;43)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLA/Ao Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBefore\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.83 (1.14\u0026ndash;2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.80 (0.60\u0026ndash;2.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.715\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eAfter\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.15 (2.14\u0026ndash;2.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.83 (1.71\u0026ndash;2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDA diameter (mm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBefore\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.0 (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.0 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eAfter\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.0 (0\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.0 (0\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eSBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eDA: Ductus Arteriosus, EF: Ejection Fraction, FS: Fractional Shortening, LA/Ao ratio: Left atrium to aortic root, BP: Blood Pressure.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThere was a statistically significant difference between the mesenteric rSpo\u003csub\u003e2\u003c/sub\u003emeasurement values obtained at four different times (p:0,018). The mean value obtained at T1 was 60.33, while the mean values obtained at T2,T3 and T4 were 62.22, 63.43 and 63.32, respectively. The measurement value obtained at time T1 was lower than the values obtained at other times and there was a statistically significant difference. There was also a statistically significant difference in diastolic BP, mean BP, values obtained at 4 different times. When we compared all patients according to different time intervals, there was no statistically significant difference in cerebral rSpO\u003csub\u003e2\u003c/sub\u003e, cerebral FTOE and SpO\u003csub\u003e2\u003c/sub\u003e, intestinal FTOE, right and left rSpO\u003csub\u003e2\u003c/sub\u003eand FTOE values. Comparison of rSpO\u003csub\u003e2\u003c/sub\u003e, FTOE and SpO\u003csub\u003e2\u003c/sub\u003emeasurements at different time points is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of rSpO\u003csub\u003e2\u003c/sub\u003e, SpO\u003csub\u003e(2),\u003c/sub\u003eand FTOE measurements at different time points\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSystolic BP, mm Hg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66.14\u0026thinsp;\u0026plusmn;\u0026thinsp;10.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.23\u0026thinsp;\u0026plusmn;\u0026thinsp;10.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.47\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiastolic BP, mm Hg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.13\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean BP, mm Hg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.73\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e51.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBrain rSpO\u003c/b\u003e\u003csub\u003e\u003cb\u003e₂\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.131\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMesenteric\u003c/b\u003e \u003csub\u003e\u003cb\u003erSpO₂\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.43\u0026thinsp;\u0026plusmn;\u0026thinsp;7.29\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.05\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRight Kidney rSpO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.99\u0026thinsp;\u0026plusmn;\u0026thinsp;7.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.728\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeft Kidney rSpO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.42\u0026thinsp;\u0026plusmn;\u0026thinsp;6.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68.24\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.457\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSpO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e93.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.162\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBrain FTOE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.201\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntestinal FTOE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRight Kidney FTOE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.613\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeft Kidney FTOE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003e\u003cem\u003erSpO₂\u003c/em\u003e\u003c/sub\u003e: \u003cem\u003eRegional tissue oxygenation\u003c/em\u003e, \u003csub\u003e\u003cem\u003eSpO₂\u003c/em\u003e\u003c/sub\u003e: \u003cem\u003eoxygen saturation, FTOE: Fractional Tissue Oxygen Extraction.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u003cem\u003ea\u0026minus;c\u003c/em\u003e\u003c/sup\u003e: \u003cem\u003eNo significant difference between time points with the same letter\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThere was no statistically significant difference in rSpO₂, FOE and SpO₂ values in tissues according to different time intervals in the paracetamol group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the mesenteric rSpO₂ values of the patients in the ibuprofen group were found to be significantly higher at T2 time compared to the baseline value of T0 (p:0.01). Mesenteric FOE values at T2 time were lower than T0; however, this difference was not statistically significant (p:0,700). The comparison of rSpPO2, SPO2 and FTOE values according to different time intervals in paracetamol and ibuprofen group patients is shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of rSpPO2, SPO2, and FTOE values in patients in the paracetamol and ibuprofen groups at different time intervals\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eParacetamol Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e\u003cp\u003eIbuprofen Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBrain rSO2 (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e73.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e72.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e71.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e73.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e70.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.340\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMesenteric rSO2 (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.860\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e59.47\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e62.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e63.29\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e64.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRight Kidney rSO2 (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e65.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e70.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e68.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e67.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e69.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeft Kidney rSO2 (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e68.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e71.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e68.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e69.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSpO2 (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e93.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e93.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e94.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e94.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e94.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.890\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBrain FTOE (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMesenteric FTOE (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.120\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRight Kidney FTOE (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.620\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeft Kidney FTOE (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003e\u003cem\u003erSpO\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e : \u003cem\u003eRegional tissue oxygenation, SpO\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e : \u003cem\u003eoxygen saturation, FTOE: Fractional Tissue Oxygen Extraction.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study was conducted to evaluate the efficacy of paracetamol and ibuprofen in the treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in premature infants. Our findings show that both drugs are effective in the treatment of PDA, but the effects of paracetamol and ibuprofen on hemodynamic parameters and organ oxygenation may differ from each other.\u003c/p\u003e\u003cp\u003eIn the study by Navikiene et al. a significant decrease in PDA diameters was found after paracetamol and ibuprofen treatment in patients with hsPDA\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Similarly, in our study, a statistically significant reduction in PDA diameters was observed after treatment, especially in the ibuprofen-treated patient group. However, numerous systematic reviews and meta-analyses have revealed that the efficacy of paracetamol and ibuprofen on PDA closure is similar\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e,\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAs known, late initiation of medical treatment for symptomatic PDA is less effective than early (targeted or prophylactic) treatment, but it reduces the diameter of the ductus and decreases the need for surgical ligation\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Indeed, El-Khuffash et al. reported that late intravenous paracetamol administration was associated with only 25% successful ductus closure, but significantly reduced the need for surgical treatment for PDA\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. In our study, complete closure was found in eleven patients and a significant decrease in duct diameter was found in 13 patients after medical treatment. However, no significant change was found in the LA/Ao ratio.\u003c/p\u003e\u003cp\u003eAnother prominent finding in our study was a statistically significant increase in diastolic and mean blood pressure values after treatment in the ibuprofen group. As stated by Rios et al., hsPDA may be associated with circulatory disturbance and hypotension, and medical treatment may stabilize both systemic blood flow and blood pressure\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Similarly, some other studies have reported that medical treatment initiated in the presence of PDA may contribute to an increase in blood pressure\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHsPDA is known to affect regional tissue oxygenation and circulation in the brain and kidneys, which are vital organs\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In this study, we hypothesized that medical treatment may improve oxygenation at the organ level by reducing hemodynamic disturbances due to PDA and that these improvements may be used in the evaluation of treatment efficacy and clinical follow-up processes. According to our findings, a statistically significant increase in mesenteric rSpO₂ values and a decreasing trend in mesenteric FOE were observed in patients receiving ibuprofen. In contrast, there was no statistically significant change in brain tissue oxygenation and right and left kidney tissue oxygenation after treatment.\u003c/p\u003e\u003cp\u003eSome clinical studies have shown that renal tissue oxygenation is affected earlier and more markedly in the presence of hsPDA compared to brain tissue oxygenation\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. This finding suggests that closure of the PDA may primarily affect postductal circulation and oxygenation. In addition, it is known that shunt flow usually occurs in the direction affecting the lower body circulation (postductal region) \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. While brain tissue oxygenation is affected by preductal systemic perfusion, renal oxygenation is more sensitive to diastolic leakage in the postductal region\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Similarly, in our study, it was found that shunt flow due to hsPDA affected the postductal region more prominently and a statistically significant increase occurred especially in mesenteric tissue oxygenation after medical treatment.\u003c/p\u003e\u003cp\u003eIn contrast to our study, some studies have reported an increase in cerebral SpO₂ and a decrease in FOE following PDA closure\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. In some studies, only an increase in FOE was found \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Navikiene et al. found a significant increase in renal rSpO₂ and a decrease in FOE after hsPDA treatment, but did not observe a significant change in cerebral tissue oxygenation \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Dani et al. also found no significant difference in cerebral oxygenation in patients treated with paracetamol and ibuprofen\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. In our study, a statistically significant increase was found in mesenteric tissue oxygenation in infants treated with ibuprofen for hsPDA, whereas no significant change was found in brain and renal tissue oxygenation. It is thought that this may be explained by the presence of a mechanism of cerebral autoregulation, which means that cerebral blood flow may be kept constant despite blood pressure fluctuations\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIt is thought that differences in the age, body weight, PDA diameter, time of initiation of treatment, and the drugs and dosages used in the infants may cause these inconsistencies between the studies. In our study, considering that the ductus was not completely closed in most cases, but only narrowed, the fact that no significant change was found in cerebral and renal rSpO₂ and FTOE may be a possible explanation for this situation. However, it has been shown that only narrowing of the ductus leads to favorable changes in mesenteric tissue oxygenation and circulation that can be detected by NIRS. The findings suggest that mesenteric tissue rSpO₂ may be a more sensitive indicator in assessing hsPDA treatment response compared to cerebral and renal rSpO₂.\u003c/p\u003e\u003cp\u003eNIRS application times vary widely in the literature: In most of the studies, the measurement period was kept shorter than 1 hour, while only a few studies (Chock, Arman, Poon) followed up for 24 hours or longer\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. One of the strengths of our study compared to other studies is that the NIRS application period covers a longer follow-up period of 72 hours. The fact that most of the studies in this field have been conducted with small sample sizes can be considered as one of the main reasons for the inconsistencies in the literature. Similarly, an important limitation of our study is the relatively small number of patients.\u003c/p\u003e\u003cp\u003eIn conclusion, our study demonstrated that ibuprofen treatment contributed to hemodynamic balance by increasing diastolic and mean blood pressure in premature infants with hsPDA, and especially significantly improved mesenteric tissue oxygenation. In contrast, no significant change was found in cerebral and renal tissue oxygenation, which may be related to the effect of cerebral autoregulation or incomplete closure of the ductus. Mesenteric tissue oxygenation may be a more sensitive indicator for monitoring treatment response. Larger sample, multicenter and long-term follow-up studies are required to confirm our findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Source:\u003c/strong\u003e No funding was secured for this study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure:\u003c/strong\u003e All authors have no financial relationships relevant to this article to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e All authors have no conflicts of interest to disclose\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS’ CONTRIBUTIONS\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eZ.Z. performed the study design, data collection, statistical analyses, drafted the initial manuscript, and revised the manuscript. M.K. made substantial contributions to the study design and interpretation of data and revised the manuscript. A.Y. provided supervision throughout the entire process and made substantial contributions to the study design, interpretation of data and revision of the manuscript. M.T.D. performed the study design, data collection, statistical analyses S.S.U. made substantial contributions to the study design H.S. provided supervision throughout the entire process and made substantial contributions to the study design, interpretation of data and revision of the manuscript. \u0026nbsp;All authors have read the draft and approved the final manuscript as submitted.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSadler TW. Langman's Medical Embryology. \u003cem\u003ePlastic and Reconstructive Surgery\u003c/em\u003e. 1988;81(1):131.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoore KL, Persaud TV, Torchia MG. \u003cem\u003eEmbryologie: Entwicklungsstadien, Fr\u0026uuml;hentwicklung, Organogenese, Klinik\u003c/em\u003e. Elsevier, Urban \u0026amp; Fischer; 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. \u003cem\u003ePediatrics\u003c/em\u003e. May 2010;125(5):1020\u0026ndash;30. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2009-3506\u003c/span\u003e\u003cspan address=\"10.1542/peds.2009-3506\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eConrad C, Newberry D. Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population. \u003cem\u003eAdv Neonatal Care\u003c/em\u003e. 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Role of neonatologist-performed echocardiography in the assessment and management of patent ductus arteriosus physiology in the newborn. Elsevier; 2018:292\u0026ndash;297.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArlettaz R. Echocardiographic evaluation of patent ductus arteriosus in preterm infants. \u003cem\u003eFrontiers in pediatrics\u003c/em\u003e. 2017;5:147.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh Y, Fraisse A, Erdeve O, Atasay B. Echocardiographic diagnosis and hemodynamic evaluation of patent ductus arteriosus in extremely low gestational age newborn (ELGAN) infants. \u003cem\u003eFrontiers in pediatrics\u003c/em\u003e. 2020;8:573627.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGorman KM, Pinnamaneni RM, Franklin O, Foran A. Effects of ibuprofen on cerebral and somatic regional tissue oxygenation, using near-infrared spectroscopy in preterm infants\u0026thinsp;\u0026lt;\u0026thinsp;1500g with a patent ductus arteriosus. \u003cem\u003eJournal of Clinical Neonatology\u003c/em\u003e. 2015;4(3):178\u0026ndash;182.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchwarz CE, Preusche A, Wolf M, Poets CF, Franz AR. Prospective observational study on assessing the hemodynamic relevance of patent ductus arteriosus with frequency domain near-infrared spectroscopy. \u003cem\u003eBMC pediatrics\u003c/em\u003e. 2018;18(1):66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavikienė J, Liubšys A, Viršilas E, Žvirblis T, Jankauskienė A. Impact of medical treatment of hemodynamically significant patent ductus arteriosus on cerebral and renal tissue oxygenation measured by near-infrared spectroscopy in very low-birth-weight infants. \u003cem\u003eMedicina\u003c/em\u003e. 2022;58(4):475.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang X, Wang F, Wang K. Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials. \u003cem\u003eThe Journal of Maternal-Fetal \u0026amp; Neonatal Medicine\u003c/em\u003e. 2018;31(16):2216\u0026ndash;2222.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOhlsson A, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants. \u003cem\u003eCochrane Database of Systematic Reviews\u003c/em\u003e. 2018;(4)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMashally S, Banihani R, Jasani B, et al. Is late treatment with acetaminophen safe and effective in avoiding surgical ligation among extremely preterm neonates with persistent patent ductus arteriosus? \u003cem\u003eJournal of Perinatology\u003c/em\u003e. 2021;41(10):2519\u0026ndash;2525.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAfif E-K, James AT, Cleary A, Semberova J, Franklin O, Miletin J. Late medical therapy of patent ductus arteriosus using intravenous paracetamol. \u003cem\u003eArchives of Disease in Childhood-Fetal and Neonatal Edition\u003c/em\u003e. 2015;100(3):F253-F256.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRios DR, Bhattacharya S, Levy PT, McNamara PJ. Circulatory insufficiency and hypotension related to the ductus arteriosus in neonates. \u003cem\u003eFrontiers in pediatrics\u003c/em\u003e. 2018;6:62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHan UJ, Cho HJ, Cho YK, Choi YY, Ma JS. Change in blood pressure and pulse pressure in preterm infants after treatment of patent ductus arteriosus with indomethacin. \u003cem\u003eKorean circulation journal\u003c/em\u003e. 2011;41(4):203\u0026ndash;208.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetrova A, Bhatt M, Mehta R. Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus. \u003cem\u003eJournal of Perinatology\u003c/em\u003e. 2011;31(7):460\u0026ndash;464.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavikiene J, Virsilas E, Vankeviciene R, Liubsys A, Jankauskiene A. Brain and renal oxygenation measured by NIRS related to patent ductus arteriosus in preterm infants: a prospective observational study. \u003cem\u003eBMC pediatrics\u003c/em\u003e. 2021;21(1):559.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChock VY, Rose LA, Mante JV, Punn R. 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The association between NIRS and Doppler ultrasonography in preterm infants with patent ductus arteriosus. \u003cem\u003eThe Journal of Maternal-Fetal \u0026amp; Neonatal Medicine\u003c/em\u003e. 2020;33(7):1245\u0026ndash;1252.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoon WB, Tagamolila V. Cerebral perfusion and assessing hemodynamic significance for patent ductus arteriosus using near infrared red spectroscopy in very low birth weight infants. \u003cem\u003eThe Journal of Maternal-Fetal \u0026amp; Neonatal Medicine\u003c/em\u003e. 2021;34(10):1645\u0026ndash;1650.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDani C, Poggi C, Cianchi I, Corsini I, Vangi V, Pratesi S. Effect on cerebral oxygenation of paracetamol for patent ductus arteriosus in preterm infants. \u003cem\u003eEuropean journal of pediatrics\u003c/em\u003e. 2018;177(4):533\u0026ndash;539.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTsuji M, Saul JP, Du Plessis A, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. \u003cem\u003ePediatrics\u003c/em\u003e. 2000;106(4):625\u0026ndash;632.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hemodynamically Significant PDA (hsPDA), Preterm Infants, Near-Infrared Spectroscopy (NIRS), Regional Tissue Oxygenation, Mesenteric Oxygenation, Cerebral Oxygenation, Renal Oxygenation","lastPublishedDoi":"10.21203/rs.3.rs-7408735/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7408735/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Hemodynamically significant patent ductus arteriosus (hsPDA) is a frequent problem in preterm infants and may impair systemic and organ-specific oxygenation. Near-infrared spectroscopy (NIRS) provides a noninvasive tool to evaluate regional tissue oxygenation. Our aim was to investigate the effects of pharmacological closure therapy on cerebral, renal, and mesenteric tissue oxygenation in preterm infants diagnosed with hsPDA.\u003c/p\u003e\n\u003cp\u003eMethods: This prospective observational study was conducted in a tertiary neonatal intensive care unit between September 2021 and November 2024. Twenty-four preterm infants (24–34 weeks gestational age) with hsPDA confirmed by echocardiography were enrolled. Patients received either ibuprofen or paracetamol based on contraindications. Regional tissue oxygen saturation (rSpO₂) and fractional tissue oxygen extraction (FTOE) were monitored continuously using NIRS for 72 hours before and after treatment. Echocardiographic and hemodynamic parameters were also recorded.\u003c/p\u003e\n\u003cp\u003eResults: Ductus closure was achieved in 46% of cases and significant narrowing in 29%. Ibuprofen treatment resulted in a significant reduction in ductal diameter (p=0.002), whereas paracetamol did not (p=0.074). Diastolic and mean blood pressure increased significantly after treatment. Mesenteric rSpO₂ improved significantly at 24–48 hours in the ibuprofen group (p=0.01), while cerebral and renal oxygenation remained unchanged.\u003c/p\u003e\n\u003cp\u003eConclusion: Pharmacological therapy, particularly ibuprofen, improved hemodynamic stability and mesenteric oxygenation in preterm infants with hsPDA. Mesenteric rSpO₂ may serve as a more sensitive marker of treatment response than cerebral or renal oxygenation. Larger multicenter studies are warranted to confirm these findings.\u003c/p\u003e","manuscriptTitle":"Effect of Pharmacological Closure Therapy on Vital Organ Oxygenation in Premature Infants with Hemodynamically Significant Patent Ductus Arteriosis: Assessment by Near-Infrared Spectroscopy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 13:18:04","doi":"10.21203/rs.3.rs-7408735/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ea607b8-b1d1-47e0-8ef5-a245f236b0fb","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53533493,"name":"Health sciences/Medical research/Outcomes research"},{"id":53533494,"name":"Health sciences/Diseases/Cardiovascular diseases/Vascular diseases"}],"tags":[],"updatedAt":"2025-09-16T09:55:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-01 13:18:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7408735","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7408735","identity":"rs-7408735","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}