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Oral vs IV Ibuprofen for PDA
Cherif A, Khrouf N, Jabnoun S, et al. Randomized Pilot Study Comparing Oral Ibuprofen With Intravenous Ibuprofen in Very Low Birth Weight Infants With Patent Ductus Arteriosus. PEDIATRICS (Dec 2008); 122:e1256-e1261. Full Text | PDF
Background. We conducted a prospective, randomized, single-masked pilot study with the principal aim of comparing efficacy and tolerance between oral and intravenous ibuprofen in early closure of patent ductus arteriosus in very low birth weight infants. The possibility of ductal closure with only 1 or 2 doses of treatment was a secondary objective.
Materials and Methods. Sixty-four very low birth weight patients with echocardiographically confirmed patent ductus arteriosus and respiratory distress were studied. The patients were randomly assigned to receive either oral (group O, n = 32) or intravenous (group I, n = 32) ibuprofen starting on the third day of life. After the first dose of treatment in both groups, echocardiographic evaluation was performed to determine the need for a second or third dose. The rate of ductal closure, adverse effects, complications, and the patient's clinical course were recorded.
Results. In each group, 24 (75%) patients were born after 28 weeks' gestation. The rate of ductal closure tended to increase in group O (84.3% vs. 62.5%). Closure of the ductus was obtained after 1 or 2 doses of treatment in 19 (70.3%) of 27 patients in group O and 14 (70%) of 20 patients in group I. The adverse effects were increased in group I (31.2% vs. 9.3%). There were no significant differences with respect to complications during the stay. Adverse effects were significantly fewer when closure was achieved after an incomplete course of treatment (23.1% vs. 76.9%).
Conclusions. In very low birth weight infants, the rate of early ductal closure with oral ibuprofen is at least as good as with the intravenous route. Ductal closure may be obtained with an incomplete course of ibuprofen. Oral ibuprofen is associated with fewer adverse effects. However, a larger sample is needed for more definitive conclusions.
Comments. Oral Ibuprofen appears to work BETTER that the IV preparation for closing the ductus in VLBW infants, and with fewer side effects. An added benefit in the United States is that the oral preparation costs only pennies a dose, vs. $500/dose for the IV preparation. The study also raises the question of whether we should re-echo after each dose of indomethacin, as 70% of patients permanently closed their PDA after only 1 or 2 doses. ABK