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

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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
Volume 15, Issue 08, 2012
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.

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