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PEDIATRICS Vol. 112 No. 5 November 2003, pp. e354-e354

ELECTRONIC ARTICLE

Closure of Patent Ductus Arteriosus With Oral Ibuprofen Suspension in Premature Newborns: A Pilot Study

Eli Heyman, MD*, Iris Morag, MD*, David Batash, MD*, Rimona Keidar, MD*, Shaul Baram, MD{ddagger} and Matitiahu Berkovitch, MD§

* Neonatal Intensive Care Unit
{ddagger} Pediatric Cardiology Unit
§ Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Objective. Patent ductus arteriosus (PDA), a common finding among premature infants, is conventionally treated by intravenous indomethacin. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reactions in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to determine whether oral ibuprofen treatment is efficacious and safe in closure of a PDA in premature infants with respiratory distress syndrome.

Methods. Twenty-two preterm newborns (gestational age: 27.5 ± 1.75 [range: 23.9–31 weeks]; weight: 979 ± 266 [range: 380-1500 g]) with PDA and respiratory distress syndrome were studied prospectively. They received oral ibuprofen suspension 10 mg/kg/body weight for the first dose, followed at 24-hour intervals by 2 additional doses of 5 mg/kg each, if needed, starting on the second day of life. Echocardiography was performed before treatment and 24 hours after each dose. Every child underwent cranial ultrasonography before and after each ibuprofen dose. The rate of ductal closure, the need for additional treatment, side effects, complications, and the infants’ clinical courses were recorded.

Results. Ductal closure was achieved in all newborns except for 1 (95.5%), in whom clinically nonsignificant ductal shunting persisted. No infant required surgical ligation of the ductus. There was no reopening of the ductus after closure had been achieved. Fourteen newborns were treated with 1 dose of ibuprofen, 6 were treated with 2 doses, and the remaining 2 were treated with 3 doses. The survival rate at 1 month was 86.4% (19 of 22). Three (13.6%) infants died from the following causes: 1 who was born at 24 weeks’ gestation with a birth weight of 380 g died as a result of extreme prematurity complications, necrotizing enterocolitis, and low birth weight; 1 died as a result of Candida sepsis; and the third died as a result of Klebsiella sepsis. Intraventricular hemorrhage was observed in 7 infants. The classification was changed from grade 2 to grade 3 in 1 and from grade 0 to grade 1 or higher in 3 others. The rate of survival to discharge was 86.4% (19 of 22). No bronchopulmonary dysplasia was observed in the study group, and there was no case of tendency to bleed. There were no significant differences in the levels of serum creatinine before and after treatment with oral ibuprofen.

Conclusions. Oral ibuprofen suspension may be an effective and safe alternative for PDA closure in premature infants with PDA. However, larger comparative studies are warranted.

Key Words: oral ibuprofen • patent ductus arteriosus • premature newborns

Abbreviations: PDA, patent ductus arteriosus • RDS, respiratory distress syndrome • IVH, intraventricular hemorrhage • NEC, necrotizing enterocolitis

Received for publication Feb 18, 2003; Accepted Jul 16, 2003.


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eLetters:

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Is oral ibuprofen so efficacious in closure of PDA?
Serdar Umit Sarici, et al.
Pediatrics Online, 22 Jan 2004 [Full text]
Re: Is oral ibuprofen so efficacious in closure of PDA?
Matitiahu Berkovitch, et al.
Pediatrics Online, 10 Feb 2004 [Full text]