Oral Ibuprofen Therapy for Patent Ductus Arteriosus in Very Low Birth Weight Infants

Background-Patent ductus arteriosus is found in 45% of infants under 1500gr and in infants weighing < 1000gr, the incidence is closer to 80%. Indomethacin has been shown to close the ductus arteriosus in a large fraction of premature infants. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reactions in preterm infants. If equally effective, then oral ibuprofen for patent ductus arteriosus (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 closure of PDA in very low birth weight infants with respiratory distress syndrome (RDS). Methods-30 preterm newborns (gestational age 28.3 +/- 2.6 weeks), mean weight 1130 +/- 312gm, with PDA and RDS were studied prospectively. They received oral ibuprofen suspension 10mg/kg/body weight for the first dose, followed at 24 hour intervals by two additional doses of 5mg/kg each, if needed, starting on the second day of life. Echocardiographies were performed before treatment and 24 hours after the second dose. The rate of ductal closure, the need for additional treatment, side effects, complications and the infants' clinical courses were recorded. Results-Ductal closure was achieved in 28 newborns (93.3%), and in two others partial closure was achieved with no important shunts persisting. No infants required surgical ligation of ducts. There was no reopening of the ductus after closure had been achieved. 21 newborns were treated with one dose of ibuprofen, five were treated with two doses and the remaining two were treated with three doses. There were no significant differences in the levels of serum creatinine before and after treatment with oral ibuprofen. Conclusion-Oral ibuprofen suspension may be an effective and safe alternative for PDA closure in premature infants with PDA. However larger comparative studies are warranted