Article Text
Abstract
Background Ibuprofen is currently the only intravenous drug for treating patent ductus arteriosus (PDA). Most efficacy data relates to preterm infants within the first week of life. Currently there is a trend in the literature advocating ‘late symptomatic’ treatment, therefore treatment is often commenced after the first week of life which may affect efficacy, as suggested by previous pharmacokinetic studies.
Aim Assess the efficacy of ibuprofen in PDA closure in preterm infants (<28 weeks) when treatment was commenced after the first week of life.
Methods Retrospective review over 3 years of patients treated with ibuprofen at a tertiary neonatal unit. Four outcome measures were used; A no further treatment required, B no longer haemodynamically significant, C diameter <1.5 mm, D closed/no flow on echocardiography.
Results 21 patients were identified retrospectively with (male: female 14:7) mean gestational age 25+3(24+1–27+1)days, mean birth weight 763(520–1060)g. 57% received one course, 38% 2 courses, 5% 3 courses, and 33% underwent PDA ligation. The complication rate was 9.4% following the 1st course and 14% following the 2nd course.
The efficacy of ibuprofen varied depending on the outcome criteria (5–47% following the 1st course, 14–43% after the 2nd course).
Conclusion There is wide variation in efficacy depending on the outcome measure used. When using echocardiographic criteria (B-D), the efficacy of the first and second courses was up to 16% and 29%, respectively. Further trials are needed to standardise the assessment of efficacy and defining the treatment failure rate when ibuprofen is commenced after the first week of life in preterm infants.
Flow diagram demonstrating the efficacy of ibuprofen using the various criteria