Prophylaxis of patent ductus arteriosus with ibuprofen in preterm infants

• Published in: Acta Paediatrica Vol. 89; no. 11; pp. 1369 - 1374
• Main Authors: Dani, C, Bertini, G, Reali, MF, Murru, P, Fabris, C, Vangi, V, Rubaltelli, FF
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-11-2000; Blackwell
• Subjects: Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Apgar Score; Biological and medical sciences; Birth Weight; Cyclooxygenase Inhibitors - administration & dosage; Cyclooxygenase Inhibitors - therapeutic use; Data Interpretation, Statistical; Ductus Arteriosus, Patent - diagnostic imaging; Ductus Arteriosus, Patent - epidemiology; Ductus Arteriosus, Patent - prevention & control; Echocardiography, Doppler; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Gestational Age; Humans; Ibuprofen; Ibuprofen - administration & dosage; Ibuprofen - therapeutic use; Incidence; Infant, Newborn; Infant, Premature; Injections, Intravenous; Intensive care medicine; Male; Medical sciences; newborn; patent ductus arteriosus; Respiration, Artificial; respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - complications; Respiratory Distress Syndrome, Newborn - diagnosis; Respiratory Distress Syndrome, Newborn - therapy; Time Factors; Human; Premature; Chemoprophylaxis; Respiratory disease; Persistent fetal circulation; Treatment efficiency; Cardiovascular disease; Ductus arteriosus; Congenital disease; Non steroidal antiinflammatory agent; Persistence; Prevention; Newborn; Heart disease; Ibuprofen; Arylpropionic acid derivatives; Respiratory distress
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2000.tb00767.x

The aim of our study was to evaluate whether the prophylactic use of ibuprofen would reduce the incidence of significant patent ductus arteriosus (PDA) and to confirm the effectiveness of ibuprofen as rescue treatment in closing PDA. Eighty preterm infants with gestational age less than 34 wk with infant respiratory distress syndrome (iRDS) were randomized to receive intravenous ibuprofen lysine (10 mg/kg, followed by 5 mg/kg after 24 and 48 h) either within 24 h of life (group A) or after echocardiographic diagnosis of PDA (group B). To evaluate the severity of RDS in each patient, we calculated the initial and highest values of Oxygenation Index (O.I. =mean airway pressure × FiO2 × 100 / PaO2) and Ventilatory Index (V.I. = O.I. × mechanical respiratory rate). Other studied variables were ventilatory support, renal function, biochemical and haematological profiles, frequency of bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). On the 3rd day of life, 8% (3/40) of patients of group A and 53% of patients (21/40) of group B (p < 0.0001) developed a significant PDA. Between patients of group B who presented PDA at 3 d of life 90% (19/21) had a closure of ductus arteriosus after ibuprofen treatment. Initial and highest values of O.I. and V.I. were similar in both groups A and B. No significant differences between the groups were observed in regard to respiratory support, renal function and frequency of BPD, IVH, NEC and ROP. Ibuprofen was not associated with adverse effects.
Conclusion: Prophylactic treatment with ibuprofen reduces PDA occurrence in preterm infants with iRDS at 3 d of life in comparison with rescue treatment, but both modes are effective in closing the ductus without significant adverse effects.