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Ibuprofen vs. indomethacin for persistent ductus arteriosus closure in preterm infants

Author(s): Deny Salverra Yosy | Ria Nova | Julniar M. Tasli | Theodorus

Journal: Paediatrica Indonesiana
ISSN 0030-9311

Volume: 53;
Issue: 3;
Start page: 138;
Date: 2013;
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Keywords: persistent ductus arteriosus | preterm infants | ibuprofen | indomethacin

Background Indomethacin and ibuprofen are anti-prostaglandin E2 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 differences 0.05 to 0.17; 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 none 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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