Ibuprofen vs. indomethacin for persistent ductus arteriosus closure in preterm infants
Keywords:
persistent ductus arteriosus, preterm infants, ibuprofen, indomethacin.
Abstract
Background Indomethacin and ibuprofen are anti-prostaglandinE2 agents administered for persistent ductus arteriosus (PDA)
closure. Ibuprofen has weaker cyclooxygenase-1 inhibitor affinity
than that of indomethacin, causes decreased gastrointestinal
circulation, as well as brain and kidney side effects.
Objective To compare the efficacy of oral ibuprofen and
indomethacin for PDA closure in preterm infants.
Methods A randomized double-blind controlled trial on preterm
infants with PDA was performed in Moehammad Hoesin
Hospital, Palembang, from October to December 2011. Persistent
ductus arteriosus was diagnosed by echocardiography. Subjects
were divided into two groups, and received either ibuprofen or
indomethacin. Ibuprofen was given at a dose of 10 mg/kgBW /d
on day 1 and 5 mg/kgBW /d on days 2 and 3. Indomethacin was
given in three doses over 24 hour-intervals; the first dose was 0.2
mg/kg, and the second and third doses were 0.1 mg/kg each.
Results Sixty infants were enrolled in this study, 36 boys (60%)
and 24 girls ( 40%). Fifty-two subjects completed the study protocol.
Ductus arteriosus (DA) closure after treatment was observed in 22
out of 26 subjects in the ibuprofen group and 19 out of 26 subjects
in the indomethacin group (P= 0.04). The mean DA diameter
reductions after administration of ibuprofen or indomethacin were
0.40 (SD 0.16) mm and 0.30 (SD 0.21) mm, respectively (95%CI
of differences0.05 to0.17; P= 0.04). Serum creatinine was elevated
in the indomethacin group following treatment compared to the
ibuprofen group [P = 0.002, 95% CI of differences 0.06 to 0.27].
Ductus arteriosus reopening occurred in 4 out of 19 subjects in the
indomethacin group, while n one in the ibuprofen group .
Conclusions Ibuprofen is better than indomethacin, in terms of
higher PDA closure rate and mean DA diameter reduction after
treatment. In additional, indomethacin has significantly greater
increase in mean serum creatinine level after treatment than
ibuprofen.
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Pharmacol. 2005;19:187-93.
8. Richards },Johnson A, Fox G, Campbell M. A second course
of ibuprofen is effective in the closure of a clinically significant
PDA in ELBW infants. Pediatrics. 2009; 124:287-93.
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Weyler J, De Groote K, et al. A comparison of ibuprofen and
indomethacin for closure of patent ductus arteriosus. N Engl
J Med. 2000;343:674-81.
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renal drug clearance in neonates. J Matern Fetal Neonatal
Med. 2009;22:88-91.
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permanent closure of the ductus arteriosus: a role for
prolonged indomethacin therapy. Pediatrics. 2002; 110: 10-
6.
2006; 114: 1873-82.
2. Park MK. Pediatric cardiology for practitioners: left to right
shunt. Philadelphia: Mosby Elsevier; 2008. p. 161-91.
3. Sekar KC, Corff KE. Treatment of patent ductus arteriosus:
indomethacin or ibuprofen. J Perinatol. 2008;28:60-2.
4. Sasi A, Deorari A. Patent ductus arteriosus in preterm infants.
Indian Pediatr. 2011;48:301-8.
5. Coceani F, Liu YA, Seidlitz E, Kelsey L, Kuwaki T, Ackerley
C, et al. Endothelin a receptor is necessary for 0 2 constriction
but not closure of ductus arteriosus. Am J Physiol Heart Circ
Physiol. 1999;277:1521-31.
6. Heyman E, Morag I, Batash D, Keidar R, Baram S, Berkovitch
M. Closure of patent ductus arteriosus with oral ibuprofen
suspension in premature newborns: a pilot study. Pediatrics.
2003 ;112:354-8.
7. Panos V, Benini D, Verlato G, Errico G, Cuzzolin L. Efficacy
and renal tolerability of ibuprofen vs. indomethacin in
preterm infants with patent ductus arteriosus. Fundam Clin
Pharmacol. 2005;19:187-93.
8. Richards },Johnson A, Fox G, Campbell M. A second course
of ibuprofen is effective in the closure of a clinically significant
PDA in ELBW infants. Pediatrics. 2009; 124:287-93.
9. Van Overmeire B, Smets K, Lecoutere D, van de Broek H,
Weyler J, De Groote K, et al. A comparison of ibuprofen and
indomethacin for closure of patent ductus arteriosus. N Engl
J Med. 2000;343:674-81.
10. Allegaert K. The impact of ibuprofen or indomethacin on
renal drug clearance in neonates. J Matern Fetal Neonatal
Med. 2009;22:88-91.
11. Quinn D, Cooper B, Clyman RI. Factors associated with
permanent closure of the ductus arteriosus: a role for
prolonged indomethacin therapy. Pediatrics. 2002; 110: 10-
6.
Published
2013-06-30
How to Cite
1.
Yosy D, Nova R, Tasli J, Theodorus T. Ibuprofen vs. indomethacin for persistent ductus arteriosus closure in preterm infants. PI [Internet]. 30Jun.2013 [cited 24Nov.2024];53(3):138-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/270
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-06-30
Accepted 2016-08-21
Published 2013-06-30
