Efficacy of a first course of Ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight

PLoS One. 2015 Apr 13;10(4):e0124804. doi: 10.1371/journal.pone.0124804. eCollection 2015.

Abstract

Objective: Therapeutic strategies for patent ductus arteriosus (PDA) in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA) newborns.

Study design: This single-centre retrospective study included 185 infants born at 24+0-27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea): 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA) were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes.

Results: The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2-12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3-70.5] p=0.003).

Conclusion: There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.

MeSH terms

  • Age Factors
  • Birth Weight
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Ductus Arteriosus, Patent / drug therapy*
  • Female
  • Gestational Age
  • Hemodynamics
  • Humans
  • Ibuprofen / therapeutic use*
  • Infant, Extremely Premature / growth & development*
  • Infant, Low Birth Weight / growth & development*
  • Infant, Newborn
  • Male
  • Models, Statistical*
  • Retrospective Studies

Substances

  • Cyclooxygenase Inhibitors
  • Ibuprofen

Grant support

The authors received no specific funding for this work.