Is Oral Ibuprofen Better than Intravenous Indomethacin for Medical Closure of the Patent Ductus Arteriosus in Preterm Infants?

Abstract

Background: Patent Ductus Arteriosus is an open channel between the aorta and pulmonary artery. The incidence of patent ductus arteriosus (PDA) is approximately 40% in premature infants. Objectives and Methods: To determine the effectiveness and safety of ibuprofen compared to intravenous indomethacin for closing a PDA in preterm and/or low birth weight infants. This is a case control study, retrospective review of the files of infants in control group given intravenous indomethacin, as conventional treatment: first dose of 2 mg/kg, then two doses of 0.1 mg/kg after 12 hr, 36hr respectively if the infant is either 7 days old or >1250 g. Infants who received oral ibuprofen in case group, as a new treatment (10 mg/kg initially followed by two doses of 5 mg/kg by interval of 24 hours) for symptomatic PDA in a neonatal intensive care unit in Pediatric and Neonatology Department, King Fahad Hospital Albaha, from January 2007 till December 2013. Only patients with isolated PDA included, while PDA associated with other congenital heart disease was excluded. Results: A total of 104 infants as control (group 1) received IV indomethacin, and 104 pts as a case (group 2) received oral ibuprofen. Among the survivors, the closure rate was 89.4% (93/104) in the indomethacin group and 91.3% (95/104) in the ibuprofen group (p =0.443). Significantly the incidence of complications was lower in the ibuprofen group: elevated serum creatinine (14.4% versus7.7%), oliguria (19.2 % versus 9.6%), and upper gastrointestinal hemorrhage (11.5 versus 4.8%); respectively (p: 0.034, p: 0.038, and p: 0.048). The incidence of necrotizing enterocolitis was higher in the indomethacin group (5.8% versus 3.9%) but not significant (p: 0.233). Conclusion: oral ibuprofen is as effective as intravenous indomethacin for closure of PDA and is associated with significantly less complications.