A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus

Thomas, Ronald; Parker, Graham C.; Overmeire, Bart Van; Aranda, Jacob V.

doi:10.1007/s00431-004-1596-5

Cited by 129 publications

(78 citation statements)

References 33 publications

(75 reference statements)

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“…Indomethacin therapy was associated with thrombocytopenia (36%), azotaemia (31%), sepsis (30%), oliguria (25%), hyponatraemia (25%), IVH (16%), pulmonary interstitial emphysema (11%), NEC (8%), intestinal perforation (4%) and bleeding (3%). Similar adverse effects have been reported in other studies and it has been additionally shown that Ibuprofen may be associated with lower serum creatinine values, higher urine outputs and less adverse peripheral vasoconstrictive effects compared to Indomethacin [49].…”

Section: Medical Therapysupporting

confidence: 86%

Controversies in Management of Patent Ductus Arterious in the Preterm Infant

Sinha

2013

J Pulm Respir Med

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The management of patent ductus arteriosus in the preterm infant is one of the areas of clinical care that is subjected to great practice variation. This is sadly one of the consequences of widespread adoption of closure of the patent ductus arteriosus by pharmacological or surgical means without subjecting the treatment approaches to rigorous randomized control trials. The diverse approaches to treatment currently range from early and aggressive closure of the ductus arteriosus to a conservative approach of watchful waiting for spontaneous closure. This review reviews the complex management strategies of the ductus arteriosus highlighting the areas of greatest controversy that need to be addressed in future trials to provide greatest benefit to the vulnerable preterm infant.

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Section: Medical Therapysupporting

confidence: 86%

Controversies in Management of Patent Ductus Arterious in the Preterm Infant

Sinha

2013

J Pulm Respir Med

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“…First is that all the alternatives to close the PDA have negative effects. [24][25][26][27][28] A second one is that, with time, an important number of PDA's close spontaneously. [29][30][31] The third one is that this clinical condition has a wide range of severity.…”

Section: Introductionmentioning

confidence: 99%

Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants

2012

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Objective: Patent ductus arteriosus (PDA) is a common condition among preterm infants. Controversy exists regarding the risk-benefit ratio of early closure of PDAs by either medical or surgical treatments. On the other hand, potential morbidities associated with no or delayed closure has not been well studied. The objective of the study was to determine if there is an association of prolonged persistent PDA (PP-PDA) with various morbidities in infants p28 weeks or 1250 g.Study Design: This matched case-control analysis includes preterm infants with a diagnosis of PDA over a period of 28 months in a single level III center in the USA. The predictive variable was the presence of a PP-PDA (PDA>3 weeks). Cases were infants with PP-PDA and controls were those with PDA but not PP-PDA (two controls for each case). Outcome variables included days on mechanical ventilation and with oxygen treatment, length of hospital stay, bronchopulmonary dysplasia (BPD), retinopathy of prematurity stage III-V (ROP) necrotizing enterocolitis grade II or more (NEC), delayed growth, direct hyperbilirubinemia >4 mg dl À1 and osteopenia of prematurity. Data was obtained from database collected prospectively and from the review of clinical records when necessary. Statistics included ANOVA, Kaplan-Meier curves and w 2 . Significance was set at P<0.05.Result: PP-PDA was associated with a significant increase in the number of days of mechanical ventilation, oxygen treatment and length of hospital stay, and in the rates of BPD (60% vs 4.5%), NEC (29% vs 5%), ROP (43% vs 5%), direct hyperbilirubinemia (41% vs 3%), osteopenia (44% vs 6%), parenteral nutrition for >40 days (70% vs 21%), tracheostomy during the hospitalization (15% vs 0%) and delayed growth (70% vs 21%), were also significantly higher in babies with PP-PDA. Conclusion:A prolonged exposure to PDA does not seem to be inconsequential for some infants and is associated with an increase prevalence of severe morbidities with potential long lasting effects.

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“…30 Studies comparing indomethacin and ibuprofen lysine showed equal efficacy rates in ductal closure. 7,31 In these comparative trials, the indomethacin group had statistically significant higher incidence of oliguria and elevated creatinine levels. There were no differences in the incidence of NEC, BPD or short-term neurological outcomes in patients receiving either of these COX inhibitors.…”

Section: Treatment Options For Pdamentioning

confidence: 95%

“…[22][23][24] Meta-analysis of several comparison studies has reconfirmed these observations. 31 Recent analysis of children at 4 ½ and 8 years of age who were treated with indomethacin prophylaxis at birth showed favorable neurodevelopmental outcome vs those treated with placebo. 32,33 Long-term neurological outcome in infants who received ibuprofen lysine is not yet available since it has only been approved for use since 2006.…”

Section: Treatment Options For Pdamentioning

confidence: 99%

Treatment of patent ductus arteriosus: indomethacin or ibuprofen?

Sekar

Corff

2008

J Perinatol

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Persistent patent ductus arteriosus (PDA) in preterm infants can result in serious hemodynamic changes causing respiratory, gastrointestinal and renal morbidities if not treated within the first week of life. The treatment options available are a conservative approach, pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The COX inhibitors approved for use in the United States are indomethacin and ibuprofen lysine. Both of these drugs are equally effective in closing the PDA. Subtle differences exist between these two preparations. Indomethacin has a protective effect on the incidence of intraventricular hemorrhage (IVH) but reduces the blood flow to the kidneys and the brain. Ibuprofen is less toxic but has no effect on IVH. Efficacy of pharmacological treatment is influenced by timing of initiation of therapy. Surgical treatment is the only option when pharmacological treatment fails to close the PDA in symptomatic infants. Long-term neurological and respiratory morbidities are associated with surgical ligation. This paper reviews these medical considerations in the treatment options for PDA in premature infants.

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A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus

Abstract: ibuprofen and indomethacin have similar efficacy in patent ductus arteriosus closure, but preterm infants treated with ibuprofen experience lower serum creatinine values, higher urine output, and less undesirable decreased organ blood flow and vasoconstrictive adverse effects.

Cited by 129 publications

References 33 publications

Controversies in Management of Patent Ductus Arterious in the Preterm Infant

Controversies in Management of Patent Ductus Arterious in the Preterm Infant

Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants

Treatment of patent ductus arteriosus: indomethacin or ibuprofen?

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