Use of rectal ibuprofen for PDA closure in preterm neonates

Objective To evaluate efficacy and safety of rectal form of ibuprofen and comparing to indomethacin for treatment of patent ductus arteriosus (PDA) in premature neonates. Methods Single-center, cohort, prospective study without prerandomization was performed in 38 preterm infants at gestational age 25-31 weeks were treated in NICU of Dnepropetrovsk Regional Children's Hospital (Ukraine) during 2010-2012. At admission PDA diameter, direction of shunt and hemodynamic significance of the duct were determined in premature neonate using ultrasound (US) and Doppler. All patients received restrictive infusion therapy and dobutamine intravenously. Cyclooxygenase (COX) inhibitors were administered for 3 days; if ultrasound examination verified hemodynamically significant PDA (HSPDA), the treatment was continued until PDA closure but not longer than 14 days. Children of the 1 group (n=20) received oral indomethacin during 3 days; in case of gut paresis treatment was continued by i.v. or rectal ibuprofen. Patients of the 2 group (n=10) were prescribed oral indomethacin only and in 3 group (n=8) only ibuprofen was used in rectal form. Results In patients received rectal form of ibuprofen PDA was completely closed on the average two times faster (the difference is significant, p<0.05). In patients of all three groups, conservative therapy was effective: no need for surgical treatment (duct clipping) appeared. None of the patients developed necrotic enterocolitis (NEC) stage 3 and intraventricular hemorrhage (IVH) grades 3-4. The choice of COX inhibitors had no influence on the severity of bronchopulmonary dysplasia. No mortality occurred in all groups of patients. Conclusions The use of rectal ibuprofen is a cheap, effective and safe method for PDA closure and might be an alternative to intravenous way of administration. Rectal and parenteral forms of ibuprofen demonstrated similar effectiveness in treatment of the PDA. As far as the COX inhibitors were studied in small groups of patients, this research should be continued.