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Variation and comparative effectiveness of patent ductus arteriosus pharmacotherapy in extremely low birth weight

N O ElHassan1, T M Bird2, A J King3

  • 1University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA.

Journal of Neonatal-Perinatal Medicine
|October 18, 2014
PubMed

Insights

Ibuprofen (IBU) is preferred over indomethacin (INDO) for treating patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. IBU use increased, and renal failure was less common compared to INDO.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pharmacology
  • Clinical Outcomes Research

Background:

  • Patent ductus arteriosus (PDA) affects 70% of extremely low birth weight (ELBW) infants, often leading to significant morbidities.
  • Spontaneous closure of PDA occurs in only 34% of ELBW infants, necessitating therapeutic intervention.

Purpose of the Study:

  • To analyze temporal and inter-hospital variations in early indomethacin (INDO) versus ibuprofen (IBU) use for PDA treatment in outborn ELBW infants.
  • To compare the clinical outcomes and side effects of INDO and IBU in this vulnerable population.

Main Methods:

  • Retrospective analysis of the Pediatric Health Information System database for ELBW infants (birth weight <1000 g) between 2007-2010.
  • Inclusion of 732 infants diagnosed with PDA, comparing outcomes like mortality, surgical ligation, and specific morbidities (IVH, NEC, BPD, PVL, renal failure, PPHN).
  • Utilized chi-square, multivariable regression, and instrumental variable analysis to control for confounding factors and selection bias.

Main Results:

  • Significant variability observed in PDA pharmacotherapy administration over time and across different hospitals.
  • Indomethacin (INDO) use decreased as ibuprofen (IBU) use increased from 12.8% to 38.9%.
  • Renal failure was a more frequent complication in infants treated with INDO compared to IBU.

Conclusions:

  • Wide variability exists in the pharmacologic management of PDA in ELBW infants.
  • Indomethacin (INDO) use is associated with a higher incidence of renal failure compared to ibuprofen (IBU).
  • Current data suggest ibuprofen (IBU) as the preferred pharmacologic agent for PDA treatment in ELBW infants pending further long-term comparative studies.
Abstract

Keywords:
Patent ductus arteriosusextremely low birth weight infantsibuprofenindomethacin

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