Total serum bilirubin levels during cyclooxygenase inhibitor treatment for patent ductus arteriosus in preterm infants

• Published in: Acta Paediatrica Vol. 98; no. 1; pp. 36 - 42
• Main Authors: Rheinlaender, C, Helfenstein, D, Walch, E, Berns, M, Obladen, M, Koehne, P
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-01-2009; Blackwell
• Subjects: Bilirubin; Bilirubin - blood; Biological and medical sciences; Child, Preschool; Cyclooxygenase Inhibitors - administration & dosage; Cyclooxygenase Inhibitors - adverse effects; Ductus Arteriosus, Patent - blood; Ductus Arteriosus, Patent - drug therapy; Ductus Arteriosus, Patent - physiopathology; Female; General aspects; Hemodynamics; Humans; Hyperbilirubinemia - blood; Hyperbilirubinemia - chemically induced; Hyperbilirubinemia - complications; Ibuprofen; Ibuprofen - administration & dosage; Ibuprofen - adverse effects; Indomethacin; Indomethacin - administration & dosage; Indomethacin - adverse effects; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Male; Medical sciences; Outcome; PDA; Retrospective Studies; Personal digital assistant; Premature; Prostaglandin-endoperoxide synthase; Pediatrics; Prognosis; Indometacin; Infant; Bilirubin; PDA; Tocolytic; Clinical biology; Ibuprofen; Indoleacetic acid derivatives; Arylpropionic acid derivatives; Evolution; Human; Enzyme; Enzyme inhibitor; Persistence of ductus arteriosus; Non steroidal antiinflammatory agent; Newborn diseases; Treatment; Prematurity; Outcome; Total; Oxidoreductases; Indomethacin
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2008.01007.x

Aim: To determine whether ibuprofen use in VLBW infants is associated with increased serum bilirubin levels and impaired neurodevelopmental outcome at 2 years of age compared to indomethacin.
Methods: We retrospectively evaluated bilirubin data and outcome parameters of 178 VLBW infants treated with COX inhibitors for a haemodynamically relevant patent ductus arteriosus (PDA) between 1998 and 2003 in a single institution. In our department ibuprofen replaced indomethacin for PDA treatment in 2001, while clinical and echocardiagraphic criteria for the indication of PDA invention have remained unchanged.
Results: Ibuprofen and indomethacin therapy groups did not differ in their baseline clinical profile. Peak serum bilirubin concentration was 10.2 mg/dL in the ibuprofen group and 8.6 mg/dL in the indomethacin group (p < 0.01), while phototherapy duration did not differ. At 2 years of age neurodevelopmental outcome was similar in both groups. In a single case analysis, four cases of adverse neurodevelopmental outcome despite inconspicuous clinical course were identified in the ibuprofen group.
Conclusion: In VLBW infants with PDA, ibuprofen treatment was associated with higher bilirubin levels than indomethacin.