Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Abstract

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.

Oral versus intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low birthweight infants

“…In this study, NEC occurred in 8.8% of the intravenous group and in 5.6% of the oral group. In a retrospective review of 102 preterm infants who were treated by intravenous ibuprofen, Rao et al 25 demonstrated that 8.8% of preterm infants developed SIP. The authors concluded that infants at lower gestational age were at risk of SIP when treated early with intravenous ibuprofen for symptomatic PDA.…”

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

“…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.…”

Variation and comparative effectiveness of patent ductus arteriosus pharmacotherapy in extremely low birth weight infants

“…INDO has stronger COX-1 inhibition which produces more severe gastrointestinal and renal side effects than COX-2 inhibition [1]. Though, studies evaluating the use of IBU for PDA therapy in ELGANs (Extremely Low Gestational Age Neonates) reported an increased risk of oliguria and spontaneous intestinal perforation and speculated difference in drug clearance and regional prostaglandin concentration in this population [23][24][25]. IBU has also been linked to pulmonary hypertension [25] and increased risk of chronic lung disease [26].…”