Aims To compare gastrointestinal pathology, mortality and surgical ligation of PDA in infants treated for PDA with Ibuprofen and Indomethacin.
Background PDA affects 60% of infants <28 weeks gestation. Treatment options include conservative management, pharmacological intervention and surgery.
NSAIDs are effective pharmacological agents used to treat PDA. They inhibit prostaglandin synthesis via non-selective inhibition COX-1 and COX-2. COX-1 inhibition reduces cerebral, mesenteric and renal blood flow and alters platelet function. Ibuprofen has less COX1 inhibition, therefore may have reduced side effect profile. In our unit PDA treatment changed in 2010 from Indomethacin to Ibuprofen because of unavailability of Indomethacin.
Methods Demographics and outcomes from babies <31 weeks gestation and admitted (<6 days of age) between January 2008 and June 2012 were collected from a local database and Vermont Oxford Network dataset. NEC, spontaneous intestinal perforation (SIP), PDA ligation and mortality were compared in two epochs, indomethacin and Ibuprofen.
Conclusion There was a significant reduction in early NEC during the Ibuprofen epoch compared to Indomethacin epoch. These results are similar to the reduction of NEC with Ibuprofen compared to Indomethacin (RR 0.68 (95% CI 0.47 to 0.99)) reported in a recent meta-analysis (Cochrane Database Syst Rev. 2013 Apr 30; 4:CD003481). As with all cohort studies there are confounding factors including demographics factors and potential alterations in clinical practice including feeding practices between the two epochs.
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