Ibuprofen treatment after the first days of life in preterm neonates with patent ductus arteriosus. (3rd August 2021) - de Klerk, Johan C. A.
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.