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Ibuprofen versus indomethacin treatment of patent ductus arteriosus: comparative effectiveness and complications

N M Chan1, C W Law1, K F Kwan1

  • 1Department of Paediatrics, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.

Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi
|February 5, 2014
PubMed

Insights

Ibuprofen and indomethacin show similar effectiveness for closing patent ductus arteriosus in preterm infants. However, ibuprofen use was linked to more intestinal complications, suggesting it may not be safer than indomethacin.

Area of Science:

  • Neonatalogy
  • Pharmacology
  • Pediatric Cardiology

Background:

  • Patent ductus arteriosus (PDA) is a common condition in preterm infants.
  • Medical management with nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin and ibuprofen is standard therapy.
  • Comparing the efficacy and safety of these agents is crucial for clinical decision-making.

Purpose of the Study:

  • To compare the effectiveness of intravenous ibuprofen versus indomethacin for PDA closure in preterm infants.
  • To evaluate and compare the complication rates associated with both treatments.
  • To assess secondary outcomes including mortality, bronchopulmonary dysplasia, and renal function.

Main Methods:

  • Retrospective case series conducted at a tertiary referral center.
  • Analysis of 95 preterm infants treated with either indomethacin or ibuprofen for PDA.
  • Comparison of primary outcomes (medical closure failure, surgical ligation) and secondary outcomes (mortality, BPD, intestinal complications, renal function).

Main Results:

  • Both indomethacin and ibuprofen demonstrated similar rates of successful medical closure and need for surgical ligation.
  • A significantly higher incidence of intestinal complications (necrotising enterocolitis, spontaneous intestinal perforation) was observed in the ibuprofen group (P=0.043).
  • No significant differences were found in all-cause mortality, bronchopulmonary dysplasia, or renal function parameters.

Conclusions:

  • Intravenous ibuprofen and indomethacin are equally effective in achieving medical closure of PDA in preterm infants.
  • The increased rate of intestinal complications in the ibuprofen group suggests it may not offer a superior safety profile compared to indomethacin.
  • Further research may be warranted to fully elucidate the comparative safety of these agents in specific neonatal populations.
Abstract

Keywords:
Ductus arteriosus, PatentIbuprofenIndomethacinTreatment outcome

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