Evaluation of the Closure of Patent Ductus Arteriosus With Ibuprofen Compared to Indomethacin

Cory D Jackson; Amanda C Capino; Lindsay H Stuart; Jamie L Wagner

doi:10.5863/1551-6776-28.7.618

Evaluation of the Closure of Patent Ductus Arteriosus With Ibuprofen Compared to Indomethacin

J Pediatr Pharmacol Ther. 2023;28(7):618-627. doi: 10.5863/1551-6776-28.7.618. Epub 2023 Nov 23.

Authors

Cory D Jackson¹, Amanda C Capino², Lindsay H Stuart³, Jamie L Wagner⁴

Affiliations

¹ Department of Pharmacy (CJ), Jefferson Regional Medical Center, Pine Bluff, AR.
² Department of Pharmacy Practice (AC), University of Mississippi School of Pharmacy, Jackson, MS.
³ Department of Pediatric Pharmacy (LS), University of Mississippi Medical Center, Jackson, MS.
⁴ Department of Pharmacy Practice (JW), University of Mississippi School of Pharmacy, Jackson, MS.

Abstract

Objective: Limited data exist comparing indomethacin and ibuprofen for the treatment of patent ductus arteriosus (PDA). The objective was to compare the safety and efficacy of indomethacin and ibuprofen for treatment of PDA closure.

Methods: This single-center, pre-test/post-test quasi-experiment included preterm infants admitted to the neonatal intensive care unit who received indomethacin (July 1, 2013-September 30, 2015) or ibuprofen (December 1, 2015-July 31, 2019) for PDA. Patients were excluded if they were thrombocytopenic, had existing kidney injury, unresolved intraventricular hemorrhage (IVH) or necrotizing enterocolitis (NEC) at treatment initiation. Data were obtained from the electronic health record. Study outcomes were complete PDA closure, degree of PDA closure, resolution of symptoms, and new-onset acute kidney injury (AKI), IVH, or NEC.

Results: A total of 114 patients were included: 44 (39%) received indomethacin and 70 (61%) received -ibuprofen. Twenty-one (21%) patients experienced successful PDA closure within 1 week: 13 (32%) indomethacin patients and 8 (13%) ibuprofen patients (p = 0.023). PDA size reduction occurred in 43 (46%) patients with 29 (25%) experiencing complete symptom resolution. Significantly more indomethacin patients compared with ibuprofen patients experienced new-onset AKI (48% vs 17%; p < 0.001) and received concomitant nephrotoxins (68% vs 39%; p = 0.002). There were no significant differences in new-onset IVH or NEC.

Conclusions: Indomethacin administration successfully closed the PDA in more neonates than ibuprofen but resulted in higher rates of AKI. However, this was confounded by more frequent administration of concomitant nephrotoxins. Larger trials are needed to help elucidate the optimal drug for closure of the PDA in neonates.

Keywords: necrotizing enterocolitis; newborn; nonsteroidal anti-inflammatory drugs; patent ductus arteriosus; renal insufficiency; thrombocytopenia.