Comparison of ibuprofen and indometacin for early-targeted treatment of patent ductus arteriosus in extremely premature infants: a randomised controlled trial

Su, Bai-Horng; Lin, Hung‐Chih; Chiu, Hsiao-Yu; Hsieh, Hsin-Yang; Chen, Hung‐Hsin; Tsai, Yi-Ching

doi:10.1136/adc.2007.120584

Cited by 61 publications

(81 citation statements)

References 37 publications

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“…Search results and citation lists for prior publications identified 75 randomized-controlled trials of interventions that close a PDA in preterm infants. In 26 trials (five comparing long and short courses of indomethacin, [37][38][39][40][41] 19 comparing indomethacin and ibuprofen, [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and two that included very early crossover to treatment of nonresponders 29,61 ), rates of ductal closure did not differ between treatment assignments, precluding evaluation of effects of ductal closure on other outcomes, so these were excluded. The remaining 49 trials, 36, including 4728 subjects, were deemed potentially informative, as all but one documented substantial reduction in ductal patency after treatment.…”

Section: Findings From Individual Randomized-controlled Trialsmentioning

confidence: 99%

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

2010

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Section: Findings From Individual Randomized-controlled Trialsmentioning

confidence: 99%

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

2010

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“…Indomethacin, used since 1976, has been shown to be effective in producing closure of the ductus between 60 to 80% of patients, decreasing its effectiveness at younger gestational age 11,12 . In the last decade, similar results have been observed with the use of ibuprofen IV; both drugs have been shown to be equally effective in ductal closure and to reduce surgical ligation rates of PAD [13][14][15] . If closure of the PAD is not achieved with one or two cycles of NSAID therapy, surgical closure is indicated 16 .…”

Section: Introductionmentioning

confidence: 53%

Complicaciones digestivas y renales por indometacina e ibuprofeno en prematuros extremos con ductus arterioso permeable

Salas

Lavín

Rincón³

et al. 2017

Rev. chil. pediatr.

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The symptomatic patent ductus arteriosus (sPDA) is common in extremely premature infants (EPI). In order to decrease the hemodynamic repercussion and avoid complications it is necessary to close it. Indomethacin or ibuprofen are used for this purpose with its associated risks. Objective: Characterize digestive and renal complications in EPI who received indomethacin or ibuprofen as sPDA treatment. Patients and Method: Retrospective study on EPI between January-2004 and December-2013. Three groups were compared: treated with indomethacin or ibuprofen and a non-treated group. EPI with other serious complications were excluded. The primary outcomes on each group were digestive and/or renal complications. Statistical significance was p < 0.05. Results: 599 EPI were included, 33.1% with PDA received treatment and 66.9% did not need it. A statistical association was found between sPDA and lower gestational ages, neonatal depression and respiratory distress. In the non-treated group, 5% presented enterocolitis and 0.25% renal failure; on the treated group, 2.5% presented enterocolitis and 1.0% renal failure. No significant differences were found between the treated and non-treated groups in relation to complications considering enterocolitis (p = 0.11) or renal failure (p = 0.33) alone, or combined (p = 0.17). No difference were detected either between those treated with indomethacin or ibuprofen. Conclusions: The results show that in absence of other clinical complication, medical treatment of sPDA with indomethacin or ibuprofen, do not increase the risk of serious digestive or renal disorders. There were no advantages of using indomethacin or ibuprofen over the other.original arTicle 244Premature infants with patent ductus arteriosus and aine -r. Salas et al

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“…In infants without SIP, 37/93 (39.8%) infants had a moderate or large PDA after the first course of ibuprofen, whereas in the remaining, 24/93 (25.8%) had clinical or ECHO (32, 34.4%) showed closure. Eight (8,8.3%) infants without SIP received a second course of ibuprofen and three (3.2%) infants received indomethacin for persistent PDA.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported using prophylactic intravenous ibuprofen within 6 to 8 h after birth, with bowel perforation occurring in 8.0 to 8.3% of the infants, 8,21 whereas another study reported bowel perforation in 8.0% when ibuprofen (treatment) was used at a median age of 6 days. 22 Bowel perforation has also been reported in isolated infants within 48 h of oral ibuprofen prophylaxis, or with treatment of PDA.…”

Section: Discussionmentioning

confidence: 99%

“…Ibuprofen in comparison to indomethacin has been shown to have milder effects on cerebral, renal and mesenteric blood flow. 7,8,9 Impaired mesenteric circulation due to a 'diastolic steal' from a hemodynamically significant PDA, vasoconstrictive effects and local prostaglandin inhibition by indomethacin have been suggested as risk factors for the development of spontaneous intestinal perforation (SIP) and NEC; 10,11 gastrointestinal complications associated with indomethacin treatment.…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Rao

Bryowsky

Mao³

et al. 2011

J Perinatol

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Objective: To review intestinal complications associated with ibuprofen treatment of patent ductus arteriosus (PDA).Study Design: Data from preterm infants treated with ibuprofen were retrospectively reviewed. w 2 test and Fischer's exact test were used for univariate analyses. Multivariate analyses with logistic regression modeling were used to identify risk factors.Result: One hundred and two infants were treated with ibuprofen for PDA. Nine (9/102, 8.8%) infants developed spontaneous intestinal perforation (SIP), whereas 93/102 (91.2%) did not. The mean (±s.d.) gestational age (GA) at birth in infants with and without SIP was 25.2 ( ± 1.3) vs 27.6 ( ± 2.4) weeks (P ¼ 0.02) and the median (interquartile) length of stay (LOS) was 109.5 (91.0 to 116.5) vs 75.0 (53.0 to 94.5) days (P ¼ 0.002), respectively. The mean ( ± s.d.) age at starting ibuprofen was 3.3 ( ± 1.3) vs 5.8 (±3.5) days in infants with and without SIP, respectively (P ¼ 0.03). In logistic regression analyses, increasing GA and later initiation of ibuprofen treatment were protective against risk of SIP; odds ratio, 95% confidence interval (OR, 95% CI) ¼ 0.26 (0.09 to 0.75), P ¼ 0.01 and 0.63 (0.41 to 0.95), P ¼ 0.03, respectively.Conclusion: Infants at lower GA are at risk of SIP when treated early with ibuprofen for symptomatic PDA.

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Comparison of ibuprofen and indometacin for early-targeted treatment of patent ductus arteriosus in extremely premature infants: a randomised controlled trial

Cited by 61 publications

References 37 publications

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

Complicaciones digestivas y renales por indometacina e ibuprofeno en prematuros extremos con ductus arterioso permeable

Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

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