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Impact of the Time to Initiation of Indomethacin or Ibuprofen on Patent Ductus Arteriosus Closure Rates
Brooke Szachnowicz1, Julie Nogee2, Kartikeya Makker3
1Department of Pharmacy, Boston Children's Hospital, Boston, MA, USA. brooke.szachnowicz@childrens.harvard.edu.
Insights
Initiating indomethacin or ibuprofen treatment for patent ductus arteriosus (PDA) in preterm infants did not impact closure rates. Early versus late treatment for PDA showed no significant difference in outcomes.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common condition in preterm neonates.
- Timely pharmacologic intervention is crucial for managing PDA, but optimal timing remains unclear.
Purpose of the Study:
- To evaluate the clinical impact of early versus late initiation of indomethacin or ibuprofen on PDA closure rates in preterm neonates.
- To assess the association between treatment timing and the need for further interventions or adverse neonatal outcomes.
Main Methods:
- Retrospective cohort study of preterm neonates treated for PDA with indomethacin or ibuprofen.
- Patients were divided into early treatment (day of life 0-7) and late treatment (day of life 8+) cohorts.
- Primary outcome was PDA closure rate; secondary outcomes included need for additional interventions and neonatal safety.
Main Results:
- No significant difference in PDA closure rates between early (45%) and late (32%) treatment cohorts (p=0.26).
- Similar rates of repeat pharmacotherapy, surgical ligation, or transcatheter closure between groups.
- No significant differences in adverse neonatal outcomes were observed based on treatment initiation timing.
Conclusions:
- The timing of initiating indomethacin or ibuprofen for PDA in preterm neonates does not significantly influence closure rates or neonatal safety.
- Overall PDA closure rates with pharmacologic therapy were low, suggesting potential for further research into treatment efficacy.
Objective:
Our objective was to describe the clinical impact of time to initiation of indomethacin or ibuprofen on patent ductus arteriosus (PDA) closure rates in preterm neonates.
Methods:
This was a retrospective cohort study including preterm neonates who received at least one dose of intravenous indomethacin or ibuprofen as their first treatment course for PDA closure. Patients were categorized into the early treatment (ET) cohort if pharmacologic therapy was initiated on day of life (DOL) 0-7 and to the late treatment (LT) cohort if initiated on DOL 8 or later. PDA closure rate was the primary outcome, and data were also evaluated to assess the need for additional medical or surgical interventions for PDA closure, as well as neonatal safety outcomes based on time to initiation of therapy.
Results:
A total of 97 patients with a median gestational age of 25 weeks were included for analysis, with 29 in the ET cohort and 68 in the LT cohort. Baseline characteristics were similar between the ET and LT cohorts, with a median DOL of therapy initiation of 5 (interquartile range 4-6) and 11 (interquartile range 10-13.5) days, respectively. Rates of indomethacin as the initial nonsteroidal anti-inflammatory drug choice were similar between the ET and LT cohorts (66% vs 56%, p = 0.5). There was no difference in PDA closure rates following the initial course of pharmacologic therapy between the ET and LT cohorts (45% vs 32%, p = 0.26). Similarly, there was no difference in the incidence of a second pharmacologic treatment course (25% vs 26%, p = 1), surgical ligation, transcatheter closure, or adverse neonatal outcomes between cohorts.
Conclusion:
The time to initiation of intravenous indomethacin or ibuprofen did not significantly affect PDA closure rates, the need for subsequent PDA pharmacotherapy, or adverse neonatal outcomes. Overall rates of PDA closure with pharmacologic intervention were low.
