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The effects of ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants  

Choi, Wooksun (Department of Pediatrics, Korea University College of Medicine)
Shin, Jung-Yeon (Department of Pediatrics, Korea University College of Medicine)
Choi, Byung Min (Department of Pediatrics, Korea University College of Medicine)
Eun, Baik-Lin (Department of Pediatrics, Korea University College of Medicine)
Yoo, Kee Hwan (Department of Pediatrics, Korea University College of Medicine)
Hong, Young Sook (Department of Pediatrics, Korea University College of Medicine)
Lee, Joo Won (Department of Pediatrics, Korea University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.49, no.12, 2006 , pp. 1315-1323 More about this Journal
Abstract
Purpose : This study was conducted to compare the efficacy and safety of ibuprofen and indomethacin in the treatment of patent ductus arteriosus (PDA) in preterm infants and to determine whether ibuprofen can be an alternative drug. Methods : A total of 32 preterm infants with symptomatic PDA were enrolled in the study. Twelve infants received intravenous ibuprofen 10 mg/kg, followed by 5 mg/kg after 24 and 48 hours. As a comparative group, twenty premature infants received three doses of indomethacin 0.1-0.2 mg/kg every 12 hours. Results : PDA was closed in 11 of 12 infants of the ibuprofen group (92 percent) and in 18 of 20 infants of the indomethacin group (90 percent). Serum sodium concentration decreased along with time significantly (P<0.0001) and to its lowest level at 48 hours after administration of the third dose (P=0.0011) in both groups, but showed no significant difference between two groups. Serum BUN and creatinine concentrations were not changed significantly before or after treatment in each group and showed no difference between thetwo groups. The amount of urine output did not change along with time significantly in both groups (P=0.0725), and showed no significant difference between two groups. Conclusion : Ibuprofen has similar effects to indomethacin in the rate of PDA closure and complication when compared. It has similar changes in serum sodium level and complications when compared to indomethacin for the treatment of PDA in preterm infants. Therefore, intravenous ibuprofen may be used as an alternative agent in the treatment of symptomatic PDA in preterm infants.
Keywords
Ibuprofen; Indomethacin; Patent ductus arteriosus;
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1 Lin YJ, Tsai YJ, Chen JS, Lin JS, Wu JM, Lin CH, et al. Renal effects and urinary excretion of prostaglandin following indomethacin therapy in premature infants with patent ductus arteriosus. Acta Paediatr Sin 1995;36:104-7
2 Pezzati M, Vangi V, Biagiotti R, Bertini G, Cianciulli D, Rubaltelli FF. Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus. J Pediatr 1999;135:733-8   DOI   ScienceOn
3 Hardy P, Peri KG, Lahaie I, Varma DR, Chemtob S. Increased nitric oxide synthesis and action preclude choroidal vasoconstriction to hyperoxia in newborn pigs. Circulation Research 1996;79:504-11   DOI
4 Thomas RL, Parker GC, Van Overmeire B, Aranda JV. A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus. Eur J Pediatr 2005;164:135-40   DOI   ScienceOn
5 Zanardo V, Vedovato S, Lago P, Piva D, Faggian D, Chiozza L. Effects of ibuprofen and indomethacin on urinary antidiuretic hormone excretion in preterm infants treated for patent ductus arteriosus. Fetal Diagn Ther 2005;20:534-9   DOI   ScienceOn
6 Van Overmeire B, Smets K, Lecoutere D, Van de Broek H, Weyler J, Degroote K, et al. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med 2000;343:674-81   DOI   ScienceOn
7 Mosca F, Bray M, Lattanzio M, Fumagalli M, Tosetto C. Comparative evaluation of the effects of indomethacin and ibuprofen on cerebral perfusion and oxygenation in preterm infants with patent ductus arteriosus. J Pediatr 1997;131: 549-54.   DOI   ScienceOn
8 Van Overmeire B, Allegaert K, Casaer A, Debauche C, Decaluwe W, Jespers A, et al. Prophylactic ibuprofen in premature infants: a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2004;364:1945-9   DOI   ScienceOn
9 Van Overmeire B, Chemtob S. The pharmacologic closure of the patent ductus arteriosus. Semin Fetal Neonatal Med 2005;10:177-84   DOI   ScienceOn
10 Shah SS, Ohlsson A. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants (Cochrane Review). In: The Cochrane Library, Oxford: Update Software, 2003, Issue 2. Art. No. CD004213.
11 Hammerman C. Patent ductus arteriosus. Clinical relevance of prostaglandins and prostaglandin inhibitors in PDA pathophysiology and treatment. Clin Perinatol 1995;22:457-79   DOI
12 Clyman RI. Recommendations for the postnatal use of indomethacin: an analysis of four separate treatment strategies. J Pediatr 1996;128:601-7   DOI   ScienceOn
13 Fowlie PW, Davis PG. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants (Cochrane Review). In: The Cochrane Library, Oxford: Update Software, 2002, Issue 3. Art. No. CD000174
14 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9   DOI   ScienceOn
15 Farstad T, Bratlid D. Pulmonary effects of closure of patent ductus arteriosus in premature infants with severe respiratory distress syndrome. Eur J Pediatr 1994;153:903-5   DOI
16 Pellicer A, Aparicio M, Cabanas F, Valverde E, Quero J, Stiris TA. Effect of the cyclo-oxygenase blocker ibuprofen on cerebral blood volume and cerebral blood flow during normocarbia and hypercarbia in newborn piglets. Acta Pediatr 1999;88:82-8.   DOI
17 Rennie JM, Doyle J, Cooke RW. Early administration of indomethacin to preterm infants. Arch Dis Child 1986;61: 233-8   DOI   ScienceOn
18 Evans N. Current controversies in the diagnosis and treatment of patent ductus arteriosus in preterm infants. Adv Neonatal Care 2003;3:168-77   DOI
19 Patel J, Roberts I, Azzopardi D, Hamilton P, Edwards AD. Randomized double-blind controlled trial comparing the effects of ibuprofen with indomethacin on cerebral hemodynamics in preterm infants with patent ductus arteriosus. Pediatr Res 2000;47:36-42   DOI   ScienceOn
20 Desfrere L, Zohar S, Morville P, Brunhes A, Chevret S, Pons G, et al. Dose-finding study of ibuprofen in patent ductus arteriosus using the continual reassessment method. J Clin Pharm Ther 2005;30:121-32   DOI   ScienceOn
21 Fowlie PW, Davis PG. Prophylactic indomethacin for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2003;88:464-6   DOI
22 Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr 1983;102:895-906.   DOI
23 Laudignon N, Chemtob S, Bard H, Aranda JV. Effect of indomethacin on the cerebral blood flow velocity of premature newborns. Biol Neonate 1988;54:254-62   DOI   ScienceOn
24 Choi BM. Trend in the management of patent ductus arteriosus in neonates. J Korean Pediatr Cardiol 2003;7(2 Suppl):177S-84S
25 Yeh TF, Car I. Neonatal Therapeutics, 2nd ed. St Louis: Mosby Year Book, 1991;123?38
26 Kang NS, Yoo KH, Cheon H, Choi BM, Hong YS, Lee JW, et al. Indomethacin treatment decreases renal blood flow velocity in human neonates. Biol Neonate 1999;7:261-5
27 Lago P, Bettiol T, Salvadori S, Pitassi I, Vianello A, Chiandetti L, et al. Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus: a randomised controlled trial. Eur J Pediatr 2002;161:202-7.   DOI   ScienceOn
28 Shah SS, Ohlsson A. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants(Cochrane Review). In: The Cochrane Library, Oxford: Update Software, 2006, Issue 1. Art. No. CD004213
29 Supapannachart S, Limrungsikul A, Khowsathit P. Oral ibuprofen and indomethacin for treatment of patent ductus arteriosus in premature infants: a randomized trial at Ramathibodi Hospital. J Med Assoc Thai 2002;85:1252-8.
30 Van Overmeire B, Follens I, Hartmann S, Creten WL, Van Acker KJ. Treatment of patent ductus arteriosus with ibuprofen. Arch Dis Child Fetal Neonatal Ed 1997;76:179-84   DOI   ScienceOn
31 Van Bel F, Guit GL, Schipper J, van de Bor M, Baan J. Indomethacin-induced changes in renal blood flow velocity waveform in premature infants investigated with color Doppler imaging. J Pediatr 1991;118:621-6   DOI
32 Gournay V, Roze JC, Kuster A, Daoud P, Cambonie G, Hascoet JM, et al. Prophylactic ibuprofen versus placebo in very premature infants: a randomised, double-blind, placebo-controlled trial. Lancet 2004;364:1939-44   DOI   ScienceOn
33 Merritt AT, Harris JP, Roghmann K, Wood B, Campanella V, Alexson C, et al. Early closure of the patent ductus arteriosus in very low-birth-weight infants: a controlled trial. J Pediatr 1981;99:281-9   DOI
34 Knight DB. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. Semin Neonatol 2001;6:63-73
35 Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants (Cochrane Review). In: The Cochrane Library, Oxford: Update Software, 2005, Issue 4. Art. No. CD003481
36 Wyllie J. Treatment of patent ductus arteriosus. Semin Neonatol 2003;8:425-32
37 Kaplan BS, Restaino I, Raval DS, Gottlieb RP, Bernstein J. Renal failure in the neonate associated with in utero exposure to non-steroidal anti-inammatory agents. Pediatric Nephrology 1994;8:700-4.   DOI
38 Gournay V, Savagner C, Thiriez G, Kuster A, Roze JC. Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants. Lancet 2002;359:1486-8.   DOI   ScienceOn
39 Su PH, Chen JY, Su CM, Huang TC, Lee HS. Comparison of ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants. Pediatr Int 2003;45:665-70   DOI   ScienceOn
40 Zanardo V, Vedovato S, Lago P, Trevisanuto D, Favaro F, Faggian D, et al. Urinary ET-1, AVP and sodium in premature infants treated with indomethacin and ibuprofen for patent ductus arteriosus. Pediatr Nephrol 2005;20:1552-6   DOI