ORAL IBUPROFEN FOR CLOSURE OF HEMODYNAMICALLY SIGNIFICANT PATENT DULTUS ARTERIOSUS IN PREMATURE NEONATES: A PILOT STUDY

Abstract

Background- A patent ductus arteriosus (PDA), resulting in hemodynamically-significant left to right shunting of blood, increases complications and mortality in premature infants. PDA in premature infants is conventionally treated by intravenous indomethacin. Intravenous ibuprofen was recently shown to be as effective, but to have adverse reactions in premature infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to determine whether oral ibuprofen treatment is efficacious and safe in the closure of a hemodynamically significant PDA in premature infants.<br />Methods- Ten premature infants with symptomatic PDA were studied prospectively. The average gestational age and weight of them were 29.5 weeks and 1320 g, respectively. The neonates were diagnosed to have symptomatic PDA based on the clinical criteria, chest radiography and echocardiography. All the babies had CBC, PT, BUN, serum electrolytes and U/A done before and after therapy. They received oral ibuprofen for three consecutive daily doses. All the neonates underwent repeat echocardiography 24 h after three doses of ibuprofen.<br />Results- Ductus closure was achieved in all the newborns except for one (90%). There were no significant side effects like oliguria or bleeding tendencies. There was no reopening of the ductus after the closure had been achieved.<br />Conclusion- Ibuprofen, unlike indomethacin, dose not impair cerebral autoregulation and has much fewer adverse effects on the renal and mesenteric circulation. Oral ibuprofen suspension may be an effective and safe alternative for PDA closure in premature infants with PDA. However, larger comparative studies are warranted.