Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants

Cochrane: Is the use of ibuprofen compared with indomethacin, other cyclo-oxygenase inhibitors, placebo or no intervention for closing a patent ductus arteriosus (PDA) safe and effective in improving the rate of ductal closure and other important clinical outcomes in preterm or low birth weight (or both) infants?

 
Background
A common complication for very preterm (premature) or very small babies is PDA. PDA is an open vascular channel between the lungs and the heart. It should close after birth, but sometimes remains open because of the baby's immature stage of development. PDA can lead to life-threatening complications. The usual treatment for PDA has been indomethacin, a medicine that will successfully close the PDA in the majority of babies, but can cause serious side effects. Another option is the drug ibuprofen.
 

Study characteristics
We searched scientific databases for randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) in preterm infants (born at less than 37 weeks into pregnancy), low birth weight (less than 2500 g) infants, or preterm and low birth weight infants with a PDA. The treatments were ibuprofen, indomethacin, another cyclo-oxygenase inhibitor, placebo or no treatment. The evidence is current to May 2014.
 

Results
This review of 33 trials (2190 infants) found that ibuprofen was as effective as indomethacin to close a PDA and caused fewer transient side effects on the kidneys and reduced the risk of necrotising enterocolitis, a serious condition that affects the gut. Whether ibuprofen confers any important long-term advantages on development is not known. Additional long-term follow-up studies to 18 months of age and to the age of school entry are needed to decide whether ibuprofen or indomethacin is the drug of choice for closing a PDA.

 

 

Authors' conclusions: 

Ibuprofen is as effective as indomethacin in closing a PDA and currently appears to be the drug of choice. Ibuprofen reduces the risk of NEC and transient renal insufficiency. Oro-gastric administration of ibuprofen appears as effective as iv administration. To make further recommendations, studies are needed to assess the effectiveness of high-dose versus standard-dose ibuprofen, early versus expectant administration of ibuprofen, echocardiographically guided versus standard iv ibuprofen, and continuous infusion versus intermittent boluses of ibuprofen. Studies are lacking evaluating the effect of ibuprofen on longer-term outcomes in infants with PDA.