Tamara van Donge

Chapter 8 160 action of ibuprofen is related to its nephrotoxic side effects, making it challenging to disentangle between the hemodynamically and nephrotoxic effects ibuprofen possesses. It hereby illustrates the potential of a more advanced approach to explore renal adverse drug reactions in this population. The implementation of measures to prevent or minimize nephrotoxicity and close monitoring of kidney functions are mandatory in the ELBW neonate treated with ibuprofen or other NSAIDs. Due to the substantial renal adverse drug reactions, it is essential to consider the benefit-risk ratio when considering ibuprofen therapy. 21 The potential adverse drug reaction of ibuprofen affecting the kidney by a reduction of glomerular filtration is thought to depend on the degree of maturation of the neonate. Monitoring of serum creatinine concentrations, especially during the first week of life is essential to early detect these maturational adverse drug reactions. After the first week of life, the effect can still be observed and quantified, but is proportionally much more blunted (Figure 1 & 2). In conclusion, this study illustrates the difference in serum creatinine concentrations decreases with postnatal age, indicating increased clearance capacity over time (gestational, postnatal age) and illustrating the magnitude of the ibuprofen-related adverse drug reaction signal. Recognizing a change in creatinine concentrations might be useful to recognize an adverse drug reaction signal after start of ibuprofen treatment in ELBW neonates, but this signal is more pronounced in early neonatal life.