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A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus

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Abstract

Ibuprofen (IBU) has previously been shown to be as effective as indomethacin (INDO) in closing the patent ductus arteriosus (PDA) of preterm infants, without severely affecting renal hemodynamics or basal cerebral blood flow. We conducted a meta-analysis of randomized trials to compare the efficacy and safety of IBU and INDO for treatment of PDA. Data from the nine relevant trials ( n =566), showed no significant difference in the efficacy of IBU and INDO in PDA closure ( P =0.70). However, five trials ( n =443) provided serum creatinine concentration data that revealed a significantly lower increase favoring IBU ( P < 0.001), and urine output data that showed a significantly lower decrease favoring IBU ( P < 0.001). In two trials ( n =188) the proportion of infants who required postnatal oxygen therapy at 28 days (defined as chronic lung disease) was significantly higher with IBU (52/94; 55.3%) than with INDO (38/94; 40.4%, P < 0.05). No statistically significant differences were found in mortality, intraventricular hemorrhage, necrotizing enterocolitis, surgical ligation, sepsis, retinopathy of prematurity, periventricular leukomalacia, length of hospital stay, gastrointestinal bleeding, re-opening of PDA, back-up treatment, surfactant therapy, or days on a ventilator. Conclusion:ibuprofen and indomethacin have similar efficacy in patent ductus arteriosus closure, but preterm infants treated with ibuprofen experience lower serum creatinine values, higher urine output, and less undesirable decreased organ blood flow and vasoconstrictive adverse effects.

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Abbreviations

CBF :

cerebral blood flow

CBV :

cerebral blood volume

CI :

confidence interval

IBU :

ibuprofen

INDO :

indomethacin

IVH :

intraventricular hemorrhage

NEC :

necrotizing enterocolitis

PDA :

patent ductus arteriosus

RR :

relative risk

WMD :

weighted mean difference

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Author information

Authors and Affiliations

  1. Children’s Research Center of Michigan, Children’s Hospital of Michigan, 3901 Beaubien Blvd, 48201, Detroit, Michigan, USA

    Ronald L. Thomas & Graham C. Parker

  2. Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan, USA

    Ronald L. Thomas, Graham C. Parker & Jacob V. Aranda

  3. Department of Neonatology, Antwerp University Hospital, Antwerp, Belgium

    Bart Van Overmeire

  4. Pediatric Pharmacology Research Unit Network, Children’s Hospital of Michigan, Detroit, Michigan, USA

    Jacob V. Aranda

Authors
  1. Ronald L. Thomas
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  2. Graham C. Parker
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  3. Bart Van Overmeire
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  4. Jacob V. Aranda
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Corresponding author

Correspondence to Ronald L. Thomas.

Additional information

No internal or external funding source existed for this review. All authors listed had a role in study design, data collection, data analysis, data interpretation, and writing of the manuscript.

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Thomas, R.L., Parker, G.C., Van Overmeire, B. et al. A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus. Eur J Pediatr 164, 135–140 (2005). https://doi.org/10.1007/s00431-004-1596-5

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  • DOI: https://doi.org/10.1007/s00431-004-1596-5

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