Ibuprofen treatment after the first days of life in preterm neonates with patent ductus arteriosus

Abstract

Aim

Patent ductus arteriosus (PDA) is treated with ibuprofen and it is known that the clearance of ibuprofen increases with postnatal age. We aimed to study whether postnatal age-adjusted ibuprofen dosages improve the effectiveness of treatment compared to standard ibuprofen dosages after the first days of life.

Methods

A historical cohort of 207 preterm neonates treated with standard ibuprofen dosages (Group A; 2011–2015) was compared to a prospective cohort of 66 preterm neonates treated with postnatal age-adjusted ibuprofen dosages (Group B; 2015–2016).

Results

Both groups had comparable background characteristics. Treatment was started after median 6 (25–75th percentile: 4–11) and 5 (25–75th percentile: 4–11) days and effectiveness was 33.2 and 44.7% (p = .17) in groups A and B, respectively. No hemodynamically significant PDA was found in 23/49 (46.9%) of the patients born before 28 weeks after adjusted ibuprofen dosages compared to 48/162 (29.6%) after standard ibuprofen dosages (p = .04). There were significantly more reversible side effects with the postnatal age-adjusted ibuprofen dosages (p = .04).

Conclusions

There seems to be a trend to higher effectiveness with the adjusted ibuprofen dosages in preterm neonates before 28 weeks, but it is associated with more reversible side effects.

Keywords:

• Patent ductus arteriosus
• preterm neonates
• ibuprofen
• pharmacodynamics
• development
• dosing

Disclosure statement

No potential conflict of interest was reported by the authors. N. van Paassen contributed to study design and data collection. I van Beynum was responsible for performing the echocardiography and editing the manuscript. R. Flint edited the manuscript. I. Reiss supervised the design and edited the manuscript. S. Simons supervised the design and execution of the study, performed the final data analyses and contributed to the writing of the manuscript. JCA de Klerk had primary responsibility for the study design, data collection, data analysis, outcome assessment, preliminary data analysis and writing the manuscript.