Network meta-analysis of indomethacin versus ibuprofen versus placebo for PDA in preterm infants

Abstract

Intravenous indomethacin or ibuprofen administered to preterm infants for PDA at >24 h of life promoted ductal closure, but other short-term benefits were not seen. Treatment with intravenous ibuprofen may increase the risk of chronic lung disease. Good-quality evidence of treatment effect on morbidity, mortality and improved neurodevelopment is urgently needed.

What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants?

“…Our NICU's experience lends credence to the safety and efficacy of a true control group in the PDA RCT we need, that is, a control arm that patiently waits for spontaneous closure, utilizing cyclo-oxygenase inhibitors and/or LIGATE only when certain cardiorespiratory distress criteria are met. 15 …”

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.…”

Paracetamol (acetaminofeno) intravenoso para cierre de conducto arterioso permeable en prematuros ≤ 32 semanas de gestación

“…De los medicamentos de elección, el ibuprofeno es tan efectivo como la indometacina para el cierre del PCA, siendo el ibuprofeno, ya sea por vía intravenosa o por vía oral, el ideal hasta el momento, ya que reduce el riesgo de enterocolitis necrotizante y la insuficiencia renal transitoria 10 . Tanto la indometacina como el ibuprofeno promueven el cierre ductal en el 70-80% de los casos 11 . Recientemente se ha demostrado que el paracetamol es tan efectivo como el ibuprofeno para el cierre del PCA en prematuros 12,13 .…”