Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. e287-e293 (doi:10.1542/peds.2008-2232)
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ARTICLE

A Second Course of Ibuprofen Is Effective in the Closure of a Clinically Significant PDA in ELBW Infants

Justin Richards, MBBS, MRCPCH, Alice Johnson, MBBS, MRCPCH, Grenville Fox, MBCh, FRCPCH and Morag Campbell, MRCPCH, MBCh

Neonatal Intensive Care Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom

OBJECTIVES: There are few published data on the efficacy of ibuprofen in the most immature infants and no data on repeated courses. Our objectives were to describe PDA closure rates in a population of infants <1000 g birth weight after repeated courses of ibuprofen, to examine the effect of gestation, and to document plasma markers of renal function and platelet counts.

METHODS: This was a single center observational study. We collected data on infants weighing <1000 g at birth who were treated with ibuprofen for a clinically significant PDA. A successful outcome was defined as resolution of clinical symptoms such that no additional treatment was required. Serum biochemistry and hematology data were analyzed and compared with controls.

RESULTS: We identified 160 infants with a mean ± SD birth weight of 757 ± 127 g and gestation of 25.6 ± 1.4 weeks. Seventy infants closed their PDA after a single course of ibuprofen (45%) and 32/80 (40%) following a second. Infants of <26 weeks' gestation (n = 83) were less likely to respond after both the first (27.7% vs 63.6%; P < .001) and second (30.9% vs 60.0%; P = .026) courses. The postnatal decrease in plasma creatinine was delayed by ibuprofen treatment, while platelet counts and other plasma markers were unaffected.

CONCLUSIONS: In our study population, PDA closure was gestation dependant, with a cumulative closure rate of 65%. A similar proportion of infants closed their PDA following the first and second courses regardless of gestation. These data suggest that a second course of ibuprofen may be effective in closing a PDA in even the most preterm infant.

Key Words: extremely preterm infants • ibuprofen • patent ductus arteriosus

Abbreviations: DA—ductus arteriosus • PDA—patent ductus arteriosus • ELBW—extremely low birth weight • CLD—chronic lung disease • NSAID—nonsteroidal antiinflammatory drug • OR—odds ratio • CI—confidence interval

Accepted Mar 31, 2009.


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