Effect and influencing factors of oral ibuprofen or indomethacin for the treatment of preterm infant with patent ductus arteriosus

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Author:
YANG Chang-yi(Department of Neonatology, Fujian Provincial Maternity & Children Hospital,Fuzhou 350001 , China)
CHEN Han-qiang(Department of Neonatology, Fujian Provincial Maternity & Children Hospital,Fuzhou 350001 , China)
YANG Wen-qing()
REN Yan-li(Department of Neonatology, Fujian Provincial Maternity & Children Hospital,Fuzhou 350001 , China)
SHI Hui-ying(Department of Neonatology, Fujian Provincial Maternity & Children Hospital,Fuzhou 350001 , China)
Journal Title:
Chinese Journal of Perinatal Medicine
Issue:
Volume 15, Issue 08, 2012
DOI:
10.3760/cma.j.issn.1007-9408.2012.08.011
Key Word:
Ductus arteriosus, patent;Infant, premature;Ibuprofen;Indomethacin

Abstract: Objective To compare the efficacy and safety of oral ibuprofen and indomethacin for the closure of patent ductus arteriosus (PDA) in preterm infants and investigate the factors affecting the effect of indomethacin.Methods Two hundred and four preterm infants with symptomatic PDA were enrolled in this retrospective study.They were divided into two groups accroding to the admission date.From Jan.1,2007 to Dec.30,2009,44 infants orally administered ibuprofen (one course:first dose was 10 mg/kg,followed by two doses of 5 mg/kg at 24 h intervals) were as ibuprofen group.From Dec.31,2009 to Jan.31,2011,160 infants orally administered indomethacin (one course:0.2 mg/kg,at 12 h and 24 h intervals for three times) were as indomethacin group.Chisquare test,t test and rank sum test were used to compare the rate of ductal closure,side effects and complications of two groups.Influence factors of indomethacin therapy were analyzed with Logistic regression.Results There were no differences of overall ductal closure rate [77.3% (34/44) vs 70.6% (113/160),x2 =0.757,P>0.05],one course therapy [68.2% (30/44) vs 63.8%(102/160),x2=0.297,P>0.05] and two courses therapy closure rate [9.1% (4/44) vs 6.9%(11/160),x2 =0.030,P>0.05] between i buprofen group and indomethacin group.The incidences of oliguria [<1 ml/(kg ? h)] and high serum creatinine (>88 μmol/L) of indomethacin group were higher than those in ibuprofen group [21.3% (34/160) vs 6.8% (3/44),x2=4.841,P=0.028;26.9% (43/160) vs 9.1% (4/44),x2=6.156,P=0.013].Logistic regression analysis showed that small gestational age (OR=2.563,95%CI:1.099-5.976,P=0.029),neonatal respiratory distress syndrome (OR=2.407,95%CI:1.023-5.664,P=0.044)and septicemia (OR=4.575,95%CI:1.782-26.768,P=0.009) were unfavorable factors for ductal closure in preterm infants underwent indomcthacin therapy,while antenatal steroid (OR=0.530,95%CI:0.312-0.901,P=0.018) was a favorable factor.Conclusions Oral ibuprofen have the same effects as indomethacin on PDA treatment in preterm infants,but with fewer side effects on renal function in terms of urine output and serum creatinine level.Some factors such as septicemia may affect the theraputic effects.

  • [1]Noori S,McCoy M,Friedlich P,et al.Failure of ductus arteriosus closure is associated with increased mortality in preterm infants.Pediatrics,2009,123:e138-e144.
  • [2]林云峰,杨长仪,陈涵强.早产儿动脉导管未闭诊治进展.中国新生儿科杂志,2010,25:180-182.
  • [3]陈涵强,杨长仪,杨文庆,等.极低出生体重早产儿动脉导管未闭的治疗,中华围产医学杂志,2011,14:425-430.
  • [4]Satar M,Yapicioglu H,Narli N,et al.Is oral indomethacin effective in treatment of preterm infants with patent ductus arteriosus?.Turk J Pediatr,2004,46:137-141.
  • [5]陆长东,李其,何爱兰,等.静脉注射和口服吲哚美辛治疗早产儿动脉导管未闭疗效比较.实用儿科临床杂志,2004,19:558-559.
  • [6]Poon G.Ibuprofen lysine (NeoProfen) for the treatment of patent ductus arteriosus.Proc (Bayl Univ Med Cent),2007,20:83-85.
  • [7]Aly H,Lotfy W,Badrawi N,et al.Oral Ibuprofen and ductus arteriosus in premature infants:a randomized pilot study.Am J Perinatol,2007,24:267-270.
  • [8]Fakhraee SH, Badiee Z, Mojtahedzadeh S, et al.Comparison of oral ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants.中国当代儿科杂志,2007,9:399-403.
  • [9]Sharma PK,Garg SK,Narang A.A preliminary study on pharmacokinetics of oral indomethacin in premature infants in north India.IndianJ Med Res,2003,117:164-169.
  • [10]Sharma PK,Garg SK,Narang A.Pharmacokinetics of oral ibuprofen in premature infants.J Clin Pharmacol,2003,43:968-973.
  • [11]Barzilay B,Youngster I,Batash D,et al.Pharmacokinetics of oral ibuprofen for patent ductus arteriosus closure in preterm infants.Arch Dis Child Fetal Neonatal Ed,2012,97:F116-F119.
  • [12]Sekar KC,Corff KE.Treatment of patent ductus arteriosus:indomethacin or ibuprofen?.J Perinatol,2008,28 Suppl 1:S60-S62.
  • [13]Itabashi K, Ohno T, Nishida H.Indomethacin responsiveness of patent ductus arteriosus and renal abnormalities in preterm infants treated with indomethacin.J Pediatr,2003,143:203-207.
  • [14]Kushnir A,Pinheiro JM.Comparison of renal effects of ibuprofen versus indomethacin during treatment of patent ductus arteriosus in contiguous historical cohorts.BMC Clin Pharmacol,2011,11:8.
  • [15]Linder N,Bello R,Hernandez A,et al.Treatment of patent ductus arteriosus: indomethacin or ibuprofen?.Am J Perinatol,2010,27:399-404.
  • [16]Lago P,Bettiol T,Salvadori S,et al.Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus:a randomised controlled trial.Eur J Pediatr,2002,161:202-207.
  • [17]陈涵强,杨文庆,杨长仪.早产儿动脉导管未闭危险因素临床分析.中国新生儿科杂志,2010,25:24-27.
  • [18]Chorne N,Leonard C, Piecuch R,et al.Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity.Pediatrics,2007,119:1165-1174.
  • [19]Van Overmeire B,Chemtob S.The pharmacologic closure pf the patent ductus arteriosus.Semin Fetal Neonatal Med,2005,10:177-184.
  • [20]杨文庆,杨长仪,陈涵强.早产儿动脉导管未闭发病机制的研究进展.国际儿科学杂志,2010,37:26-29.
  • [21]EI-Khuffash AF,Molloy EJ.Influence of a patent ductus arteriosus on cardiac troponin T levels in preterm infants.J Pediatr,2008,153:350-353.
  • [22]Tracey KJ.Tumor necrosis factor (cachectin) in the biology of septic shock syndrome.Circ Shock,1991,35:123-128.
  • [23]Kim ES, Kim EK, Choi CW, et al.Intrauterine inflammation as a risk factor for persistent ductus arteriosus patency after cyclooxygenase inhibition in extremely low birth weight infants.J Pediatr,2010,157:745-750,el.
  • [24]Kesiak M,Nowiczewski M,Gulczy(n)ska E,et al.Can we expect decreasing the incidence of patent ductus arteriosus (PDA) in the population of premature neonates who had received antenatal steroid therapy?.Ginekol Pol,2005,76:812-818.
  • [25]Brem AS,Bins RB,Mehta S,et al.Glucocorticoids inhibit the expression of calcium-dependent potassium channels in vascular smooth muscle.Mol Genet Metab,1999,67:53-57.
  • [26]Donze A,Smith JR,Bryowsky K.Safety and efficacy of ibuprofen versus indomethacin for the treatment of patent duetus arteriosus in the preterm infant: reviewing the evidence.Neonatal Netw,2007,26:187-195.
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