Treatment of patent ductus arteriosus with ibuprofen

Abstract

Aim-To evaluate the eYciency and side eVects of ibuprofen for the early treatment of patent ductus arteriosus (PDA)and compare it with indomethacin. Methods-Forty preterm infants with gestational ages of less than 33 weeks, with respiratory distress syndrome (RDS) and echocardiographically confirmed PDA, were randomly assigned at days 2 to 3 of life to receive either intravenous indomethacin 3 × 0.2 mg/kg at 12 hour intervals or intravenous ibuprofen 1 × 10 mg/kg, followed by 5 mg/kg 24 and 48 hours later. Results-PDA closed in 15 of 20 patients from the indomethacin group (75%) and in 16 of 20 (80%) from the ibuprofen group. Seven patients (three indomethacin, four ibuprofen) required a second treatment with indomethacin and in five (three in the indomethacin group and two in the ibuprofen group) the duct was ultimately ligated. Ibuprofen patients had a better urinary output and showed no increase in serum creatinine concentrations compared with the indomethacin group. Ibuprofen was not associated with any other side eVect. Conclusions-Ibuprofen treatment seems to be as eYcient as indomethacin in closing PDA on the third day of life in preterm infants with respiratory distress syndrome and seems to have fewer renal side eVects.

Ibuprofen Versus Continuous Indomethacin in Premature Neonates With Patent Ductus Arteriosus: Is the Difference in the Mode of Administration?

“…In two trials (5,6), the proportion of infants who developed chronic lung disease was significantly higher with ibuprofen than with indomethacin. Furthermore, ibuprofen is 99% protein bound, and in vitro studies suggest that it may displace bilirubin from albuminbinding sites, thereby increasing the risk for kernicterus (30,31).…”

“…Because it purportedly lacks these side effects, ibuprofen has been proposed as a pharmacologically similar, but therapeutically preferential alternative in the treatment of PDA (5)(6)(7)(8)(9)(10)(11). Ibuprofen is also a cyclooxygenase inhibitor, which seems to be equally effective in mediating ductal closure, while minimizing adverse renal effects (11).…”

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

“…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.…”

Effect of ibuprofen L-lysinate on bilirubin binding to albumin as measured by saturation index and horseradish peroxidase assays

“…[1][2][3][4][5][6][7][8][9][10] Published trials have also demonstrated its better safety and tolerability as compared to indomethacin and its possible role in neonatal therapeutics. [11][12][13] Since the first report of drug-bilirubin interactions in the pathogenesis of kernicterus, the potential for significant drug-bilirubin interactions has become an important consideration in neonatal drug therapy.…”