Comparison of Oral Ibuprofen and Intravenous Indomethacin for the Treatment of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

Yang, Eun Mi; Song, Eun Song; Choi, Young Youn

doi:10.1016/j.jped.2013.02.006

Cited by 17 publications

(8 citation statements)

References 25 publications

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“…When comparing both drugs, the only difference noted between the ibuprofen and indomethacin was that ibuprofen was associated with a lesser increase in serum creatinine after treatment. Ibuprofen and indomethacin in neonates Pacifici GM Similar results were described by Yang et al, 18 comparing 26 low weight birth babies who received intravenous indomethacin with 22 preterm infants who received oral ibuprofen. 14 The overall rate of ductal closure was 88.5% indomethacin and 81.8% with ibuprofen.…”

Section: Intravenous Indomethacin Vs Oral Ibuprofensupporting

confidence: 75%

“…12 The overall rate of ductal closure is similar in infants treated with intravenous indomethacin and oral ibuprofen. [17][18][19] Intravenous indomethacin is associated with higher side effects than oral ibuprofen. 18,19 Intravenous ibuprofen is associated with approximately 30% greater risk of chronic lung disease than intravenous indomethacin.…”

Section: ■ Discussionmentioning

confidence: 99%

“…[17][18][19] Intravenous indomethacin is associated with higher side effects than oral ibuprofen. 18,19 Intravenous ibuprofen is associated with approximately 30% greater risk of chronic lung disease than intravenous indomethacin. 9 Oral ibuprofen appears to be as effective as intravenous ibuprofen and intravenous indomethacin for closing the patent ductus arteriosus.…”

Section: ■ Discussionmentioning

confidence: 99%

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Ibuprofen and indomethacin for the closure of the patent ductus arteriosus

Pacifici¹

2016

Medical Express

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The ductus arteriosus connects the pulmonary artery with the aorta and allows right ventricular blood to bypass the unexpanded lungs. In mature infants, the ductus arteriosus closes after birth. Patent ductus arteriosus occurs in 70% of preterm infants with a birth weight < 1,000 grams. Failure of the ductus arteriosus to close has been associated with intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leukomalacia, renal failure, and persistent pulmonary hypertension. The drugs used to treat the patent ductus arteriosus are ibuprofen and indomethacin which are potent non-selective inhibitors of cyclo-oxygenase (COX) and therefore inhibit prostaglandin E2 synthesis. Prostaglandin E2 relaxes smooth muscle and tends to inhibit the closure of the patent ductus arteriosus. Intravenous ibuprofen and indomethacin inhibit prostaglandin E2 synthesis and thereby close the patent ductus arteriosus with similar efficacy. Indomethacin reduces the blood flow velocity in kidneys, intestine and brain. Ibuprofen has less effect on blood flow velocity in these organs. There is a significant increase in serum creatinine after indomethacin administration but not after ibuprofen and infants treated with ibuprofen have higher creatinine clearance. Oliguria (urine output < 1 ml/kg/h) occurs more frequently with indomethacin than with ibuprofen. Indomethacin requires furosemide for urine output more often than ibuprofen. Ibuprofen reduces the risk of necrotizing enterocolitis and transient renal insufficiency and it is the drug of choice for closing the patent ductus arteriosus. Ibuprofen and indomethacin may be administered orally. In conclusion, intravenous ibuprofen and indomethacin close the patent ductus arteriosus at the same rate, but indomethacin is more toxic than ibuprofen.

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Section: Intravenous Indomethacin Vs Oral Ibuprofensupporting

confidence: 75%

Section: ■ Discussionmentioning

confidence: 99%

Section: ■ Discussionmentioning

confidence: 99%

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Ibuprofen and indomethacin for the closure of the patent ductus arteriosus

Pacifici¹

2016

Medical Express

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“…Studies from these countries have investigated oral preparations of paracetamol 5 – 8 and oral and rectal forms of ibuprofen. 9 – 13 …”

Section: Introductionmentioning

confidence: 99%

Oral paracetamol versus oral ibuprofen for treatment of patent ductus arteriosus

et al. 2017

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ObjectiveThis study was performed to investigate the safety and efficacy of oral paracetamol versus oral ibuprofen in the treatment of patent ductus arteriosus (PDA) in premature infants.MethodsPremature infants with PDA with a gestational age of ≤32 weeks or birth weight of ≤1500 g were included in this randomized study.ResultsA total of 120 premature infants fulfilled the inclusion criteria. Of these 120 infants, 34 fulfilled the treatment criteria and 22 were finally randomized. We found no significant difference in the mortality or primary closure rates between the two groups. We also found no significant difference in the short-term neonatal outcomes.ConclusionsEither oral paracetamol or oral ibuprofen can be used safely and effectively to treat PDA in premature infants.

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“…After a full-text review of the 87 identified manuscripts, 26 studies were identified as comparing the use of ibuprofen and indomethacin for closure of the PAD in preterm infants. Four of these studies contained data for none of the predefined endpoints of interest or had data not suitable for extraction, and thus, a total of 22 studies were included in the final pooled analysis (Figure 1 ) [ 10 - 31 ]. Of the included studies, 14 (64%) were randomized while eight (36%) were retrospective studies (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Ibuprofen Versus Indomethacin for Medical Closure of the Patent Arterial Duct: A Pooled Analysis by Route of Administration

Loomba¹,

Nijhawan²

2015

Cureus

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Introduction:Preterm infants are at increased risk of having a patent arterial duct (PAD). PADs may cause congestive heart failure, respiratory distress, necrotizing enterocolitis, and renal impairment. Consequently, in some infants, it becomes necessary to attempt closure of the PAD. Surgical closure can be difficult in small infants and is not without its risks; thus, medical closure offers advantages. Cyclooxygenase inhibitors have been used for medical closure of the PAD with both ibuprofen and indomethacin having been used clinically.Methods:We performed a systematic review of the literature to identify all studies comparing ibuprofen and indomethacin. Studies comparing ibuprofen and indomethacin for closure of the PAD in premature infants were included in the meta-analysis. A subanalysis was performed to compare the route of administration. Efficacy endpoints studied were PAD closure and surgical ligation while adverse effects studied were death in the first month of life, necrotizing enterocolitis, gastrointestinal bleeding, intestinal perforation, bronchopulmonary dysplasia in the first month of life, Grade 3 or 4 intraventricular hemorrhage, and change in the serum creatinine after treatment.Results:Ibuprofen and indomethacin were equally effective in closing the PAD in premature infants and demonstrated no difference in the incidence of adverse events. In respect to the route of administration, oral ibuprofen was as effective as intravenous indomethacin. When comparing both drugs via the intravenous route, the only difference noted between the ibuprofen and indomethacin was that ibuprofen was associated with a lesser increase in serum creatinine after treatment.Conclusion:Ibuprofen and indomethacin are equally effective in PAD closure without any difference in the incidence of adverse events. Importantly, oral ibuprofen was as effective as intravenous indomethacin.

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Comparison of Oral Ibuprofen and Intravenous Indomethacin for the Treatment of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

Abstract: In ELBW infants, oral ibuprofen is as efficacious as intravenous indomethacin for the treatment of PDA. There were no differences between the two drugs with respect to safety. Oral ibuprofen could be used as an alternative agent for the treatment of PDA in ELBW infants.

Cited by 17 publications

References 25 publications

Ibuprofen and indomethacin for the closure of the patent ductus arteriosus

Ibuprofen and indomethacin for the closure of the patent ductus arteriosus

Oral paracetamol versus oral ibuprofen for treatment of patent ductus arteriosus

Ibuprofen Versus Indomethacin for Medical Closure of the Patent Arterial Duct: A Pooled Analysis by Route of Administration

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