A Second Course of Ibuprofen Is Effective in the Closure of a Clinically Significant PDA in ELBW Infants

Abstract

In our study population, PDA closure was gestation dependant, with a cumulative closure rate of 65%. A similar proportion of infants closed their PDA following the first and second courses regardless of gestation. These data suggest that a second course of ibuprofen may be effective in closing a PDA in even the most preterm infant.

Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre

“…The rate of ligation in the present study, in infants receiving more than one course of indomethacin, although higher than reported in recent cohort studies (6,8,(10)(11)(12), was still within the range reported in the literature (4,5,15,17,18). Koehne et al (4) reported an overall ligation rate of 57% and a 34% ligation rate in 101 babies who had indomethacin treatment.…”

“…Other centres continue to perform a comparable number of ligations. A United Kingdom cohort of 172 extremely low birth weight infants with PDA had a 53% ligation rate in infants receiving more than one course of ibuprofen (18). As well, 2009 Vermont-Oxford data showed a mean ligation rate of 21% for all 24 to 26 weeks' gestational age infants.…”

“…Previous publications (4,5,15,17,18) suggested that 15% to 98% of infants receiving a second indomethacin course had a surgical ligation performed. Due to this variability, it was estimated (based on local experience) that 75% of infants who received more than one indomethacin course undergo surgical ligation.…”

Patent Ductus Arteriosus: Perinatal Risk Factors

“…The incidence of PDA in term infants has been estimated to be 57 per 1,00,000 live births [3], whereas one in every three preterm infant with a birth weight of 501 to 1500 g (very low birth weight [VLBW]) can be expected to have a PDA [4,5], contributing to significant morbidity and mortality in preterm infants. The shunting of blood through a PDA in premature infants is essentially all left-to-right.…”

Treatment strategy of patent ductus arteriosus in preterm infants

“…Vieux found a significant decrease in glomerular filtration and tubular function impairment in the ibuprofen group that was not seen in the patients who did not receive ibuprofen (30). Richards reported that the effectiveness of ibuprofen in closing a PDA decreased with a second course, and that creatinine was significantly higher in neonates receiving a second course as compared to controls (32).…”