Comparison of Oral and Intravenous Ibuprofen for Medical Closure of Patent Ductus Arteriosus: Which One Is Better?

Olukman, Özgür; Çalkavur, Şebnem; Ercan, Gülten; Atlihan, Füsun; Öner, Taliha; Tavli, Vedide; Kültürsay, Nilgün

doi:10.1111/j.1747-0803.2012.00668.x

Cited by 11 publications

(12 citation statements)

References 37 publications

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“…Several previous studies, including 1 systematic review and meta-analysis, have shown that oral ibuprofen is as effective as intravenous ibuprofen and has fewer side effects. [18–23] Further, 1 trial has specifically shown that oral ibuprofen is more effective than intravenous ibuprofen for ductal closure in VLBW infants. [24] In the long run, preterm infants who were treated with oral ibuprofen for PDA had similar neurological, neurosensory, and cognitive outcomes at 2 years of age to patients who received intravenous ibuprofen.…”

Section: Discussionmentioning

confidence: 99%

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Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

Lu¹,

Li²,

Lin³

et al. 2019

Medicine

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Paracetamol (acetaminophen) has been proposed as an alternative medication for closing hemodynamically significant patent ductus arteriosus (PDA). However, the clinical outcomes remain inconclusive in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. The aim of this study was to compare the efficacy and safety of oral paracetamol and ibuprofen for pharmacological closure of PDA in premature infants from a real-world study. This retrospective study enrolled 255 preterm infants with birthweights of ≤1.5 kg, and echocardiographically confirmed significant PDA. Subjects were classified into 3 groups: Group I (standard-dose ibuprofen group) received 10 mg/kg oral ibuprofen followed by 5 mg/kg/day for 2 days. Group II (high-dose ibuprofen group) received 10 mg/kg/day oral ibuprofen for 3 days. Group III (paracetamol group) received 15 mg/kg/6 h oral paracetamol for 3 days. On day 9 after medication start, PDA closure was achieved in 61 (71.7%) patients assigned to the high-dose ibuprofen group, (63.8%) in the standard-dose ibuprofen group, and 33 (37.9%) of those in the oral paracetamol group ( P <.001). Oral standard-dose ibuprofen was more effective than oral paracetamol ( P = .001). The ductus closed faster in the high-dose ibuprofen group than in the standard-dose group (median closure time 3.9 ± 1.0 versus 4.4 ± 1.0 days, P = .009). Total bilirubin significantly increased in the high-dose ibuprofen group ( P = .02). No gastrointestinal, renal, or hematological adverse effects were reported. Subgroup analyses indicated paracetamol was minimally effective in ELBW infants (PDA closure 13%). This study demonstrated that paracetamol may be a poor medical alternative for PDA management in VLBW and ELBW infants. High dosage ibuprofen was associated with a faster clinical improvement and higher rate of PDA closure.

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Section: Discussionmentioning

confidence: 99%

“…[21] On the other hand, at least 1 study raised concerns about increased sepsis and bronchopulmonary dysplasia incidence with oral ibuprofen as compared to intravenous ibuprofen. [23] However, the evidence overall supports the use of oral ibuprofen as a safe and effective alternative agent for the treatment of PDA in neonates.…”

Section: Discussionmentioning

confidence: 99%

Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

Lu¹,

Li²,

Lin³

et al. 2019

Medicine

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“…Considering observational studies, all 24 studies had a cohort design. Based on the Newcastle-Ottawa Quality Assessment Scale for this type of study design, 12 studies obtained a score of 9 out of [79-81, 84, 89, 91, 93-95, 97, 99, 101], nine had a score of [83,85,86,88,92,96,98,100,102], two studies a score of 7 [82,87], and one a score of 6 [90] (Appendix 6).…”

Section: Risk Of Biasmentioning

confidence: 99%

Efficacy and safety of pharmacological treatments for patent ductus arteriosus closure: A systematic review and network meta-analysis of clinical trials and observational studies

Marconi

Bettiol

Ambrosio

et al. 2019

Pharmacological Research

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Efficacy and safety profiles of different pharmacological interventions used to treat patent ductus arteriosus (PDA) are relatively unexplored. Integrating the findings of randomized clinical trials (RCTs) with those from observational studies may provide key evidence on this important issue.We aimed at estimating the relative likelihood of failure to close the PDA, need for surgical closure, and occurrence of adverse events among preterm and full-term infants treated with indomethacin, ibuprofen, or acetaminophen, placebo, or no treatment including both RCTs and observational studies.We searched PubMed, Embase, and the Register of Controlled Trials from inception to October 30, 2018. We first estimated proportions of subjects with failure to close the PDA, subjects in whom surgical closure was performed after pharmacological treatment, death, and subjects with selected adverse events (AEs). These estimates were obtained using frequentist random-effect meta-analysis of arm-specific proportions. We then compared active drugs with each other and with control (either placebo or no treatment) by summarizing results at the end of treatment reported in the papers, regardless of number of administration(s), dose, route and type of administration, and study design and quality. We also summarized primary outcome results separately at first, second and third cycles of treatment. These estimates were obtained using Bayesian random-effects network meta-analysis for mixed comparisons, and frequentist random-effect pairwise meta-analysis for direct comparisons.We included 64 RCTs and 24 observational studies including 14,568 subjects (5339 in RCTs and 9229 in observational studies, 8292 subjects received indomethacin, 4761 ibuprofen, 574 acetaminophen, and 941 control (including placebo or no intervention).The proportion of subjects with failure to close the PDA was 0.24 (95% Confidence Interval, CI: 0.20, 0.29) for indomethacin, 0.18 (0.14, 0.22) for ibuprofen, 0.19 (0.09, 0.30) for acetaminophen, and 0.59 (0.48, 0.69) for control . At end of treatment, compared to control, we found inverse associations between all active drugs and failure to close PDA (for indomethacin Odds Ratio, OR, was 0.17 [95% Credible Interval,

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“…Her iki ilacın da gastrointestinal sistem ve renal sistem üzerinde yan etkileri olabilmektedir (3)(4)(5)(6). İntravenöz ibuprofen pahalı olması ve çoğu yerde bulunamaması nedeniyle oral ibuprofen tercih edilmektedir (7,8). Son yıllarda intravenöz veya oral parasetamolun de PDA'nın medikal kapatma tedavisinde etkin olduğunu bildiren çalışmalar bildirilmiştir (9)(10)(11).…”

Section: Introductionunclassified

A Hemodynamically Significant Patent Ductus Arteriosus Case which was Closed at 38th Day with Oral Paracetamol Therapy

Akar

Almaz²,

Turgut

2019

Zeynep Kamil Tıp Bülteni

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Patent duktus arteriosus özellikle küçük prematürelerin önemli sorunlarından biridir. 25 gebelik haftasında 515 gr ağırlığında doğan prematüre bebek yenidoğan servisine yatırıldı. Respiratuvar distres sendromu (RDS) nedeniyle iki kez surfaktan tedavisi uygulanan hastanın postnatal 25. günde hemodinamik anlamlı patent duktus arteriosus (PDA) saptanması nedeniyle hastaya 2 kür oral ibuprofen tedavisi verildi. İbuprofen sonrası duktusu kapanan hastanın postnatal 38. günde klinik ve laboratuvar olarak sepsis gelişen hastanın ekokardiyografisinde (EKO) duktusunun açıldığı ve hemodinamik anlamlı olduğu saptandı. Trombositopenisi olması nedeniyle hastaya medikal kapatma tedavisi olarak oral parasetamol başlandı. Oral parasetamol tedavisi sonrası kontrol EKO'sunda PDA'nın kapandığı görüldü. Klinik izleminde hastanın genel durumu iyi seyretti. Postnatal 110. günde 2120 grama ulaşan hasta yenidoğan polikliniğine kontrole gelmek üzere taburcu edildi. Sonuç olarak ibuprofen tedavisine yanıt vermeyen ya da ibuprofen tedavisinin kontrendike olduğu durumlarda geç dönemde de parasetamol tedavisi alternatif seçenek olabilir.

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Comparison of Oral and Intravenous Ibuprofen for Medical Closure of Patent Ductus Arteriosus: Which One Is Better?

Cited by 11 publications

References 37 publications

Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

Oral ibuprofen is superior to oral paracetamol for patent ductus arteriosus in very low and extremely low birth weight infants

Efficacy and safety of pharmacological treatments for patent ductus arteriosus closure: A systematic review and network meta-analysis of clinical trials and observational studies

A Hemodynamically Significant Patent Ductus Arteriosus Case which was Closed at 38th Day with Oral Paracetamol Therapy

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