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Ibuprofen Versus Indomethacin for Medical Closure of the Patent Arterial Duct: A Pooled Analysis by Route of Administration.

Loomba R, Nijhawan K - Cureus (2015)

Bottom Line: Ibuprofen and indomethacin were equally effective in closing the PAD in premature infants and demonstrated no difference in the incidence of adverse events.In respect to the route of administration, oral ibuprofen was as effective as intravenous indomethacin.Importantly, oral ibuprofen was as effective as intravenous indomethacin.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiology Dept., Children's Hospital of Wisconsin.

ABSTRACT

Introduction: Preterm infants are at increased risk of having a patent arterial duct (PAD). PADs may cause congestive heart failure, respiratory distress, necrotizing enterocolitis, and renal impairment. Consequently, in some infants, it becomes necessary to attempt closure of the PAD. Surgical closure can be difficult in small infants and is not without its risks; thus, medical closure offers advantages. Cyclooxygenase inhibitors have been used for medical closure of the PAD with both ibuprofen and indomethacin having been used clinically.

Methods: We performed a systematic review of the literature to identify all studies comparing ibuprofen and indomethacin. Studies comparing ibuprofen and indomethacin for closure of the PAD in premature infants were included in the meta-analysis. A subanalysis was performed to compare the route of administration. Efficacy endpoints studied were PAD closure and surgical ligation while adverse effects studied were death in the first month of life, necrotizing enterocolitis, gastrointestinal bleeding, intestinal perforation, bronchopulmonary dysplasia in the first month of life, Grade 3 or 4 intraventricular hemorrhage, and change in the serum creatinine after treatment.

Results: Ibuprofen and indomethacin were equally effective in closing the PAD in premature infants and demonstrated no difference in the incidence of adverse events. In respect to the route of administration, oral ibuprofen was as effective as intravenous indomethacin. When comparing both drugs via the intravenous route, the only difference noted between the ibuprofen and indomethacin was that ibuprofen was associated with a lesser increase in serum creatinine after treatment.

Conclusion: Ibuprofen and indomethacin are equally effective in PAD closure without any difference in the incidence of adverse events. Importantly, oral ibuprofen was as effective as intravenous indomethacin.

No MeSH data available.


Related in: MedlinePlus

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FIG1: Study methodologyStudy methodology

Mentions: A total of 723 manuscripts were identified with 407 remaining after duplicates were identified and removed. Titles and abstracts of these manuscripts were reviewed, and 87 manuscripts were identified for full-text review. Of the 320 manuscripts not advancing to full-text review, 270 were excluded as there was no comparison between ibuprofen and indomethacin and 50 were excluded because they were reviews, meta-analyses, case reports, series, or letters. After a full-text review of the 87 identified manuscripts, 26 studies were identified as comparing the use of ibuprofen and indomethacin for closure of the PAD in preterm infants. Four of these studies contained data for none of the predefined endpoints of interest or had data not suitable for extraction, and thus, a total of 22 studies were included in the final pooled analysis (Figure 1) [10-31]. Of the included studies, 14 (64%) were randomized while eight (36%) were retrospective studies (Table 1).


Ibuprofen Versus Indomethacin for Medical Closure of the Patent Arterial Duct: A Pooled Analysis by Route of Administration.

Loomba R, Nijhawan K - Cureus (2015)

Study methodologyStudy methodology
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494534&req=5

FIG1: Study methodologyStudy methodology
Mentions: A total of 723 manuscripts were identified with 407 remaining after duplicates were identified and removed. Titles and abstracts of these manuscripts were reviewed, and 87 manuscripts were identified for full-text review. Of the 320 manuscripts not advancing to full-text review, 270 were excluded as there was no comparison between ibuprofen and indomethacin and 50 were excluded because they were reviews, meta-analyses, case reports, series, or letters. After a full-text review of the 87 identified manuscripts, 26 studies were identified as comparing the use of ibuprofen and indomethacin for closure of the PAD in preterm infants. Four of these studies contained data for none of the predefined endpoints of interest or had data not suitable for extraction, and thus, a total of 22 studies were included in the final pooled analysis (Figure 1) [10-31]. Of the included studies, 14 (64%) were randomized while eight (36%) were retrospective studies (Table 1).

Bottom Line: Ibuprofen and indomethacin were equally effective in closing the PAD in premature infants and demonstrated no difference in the incidence of adverse events.In respect to the route of administration, oral ibuprofen was as effective as intravenous indomethacin.Importantly, oral ibuprofen was as effective as intravenous indomethacin.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiology Dept., Children's Hospital of Wisconsin.

ABSTRACT

Introduction: Preterm infants are at increased risk of having a patent arterial duct (PAD). PADs may cause congestive heart failure, respiratory distress, necrotizing enterocolitis, and renal impairment. Consequently, in some infants, it becomes necessary to attempt closure of the PAD. Surgical closure can be difficult in small infants and is not without its risks; thus, medical closure offers advantages. Cyclooxygenase inhibitors have been used for medical closure of the PAD with both ibuprofen and indomethacin having been used clinically.

Methods: We performed a systematic review of the literature to identify all studies comparing ibuprofen and indomethacin. Studies comparing ibuprofen and indomethacin for closure of the PAD in premature infants were included in the meta-analysis. A subanalysis was performed to compare the route of administration. Efficacy endpoints studied were PAD closure and surgical ligation while adverse effects studied were death in the first month of life, necrotizing enterocolitis, gastrointestinal bleeding, intestinal perforation, bronchopulmonary dysplasia in the first month of life, Grade 3 or 4 intraventricular hemorrhage, and change in the serum creatinine after treatment.

Results: Ibuprofen and indomethacin were equally effective in closing the PAD in premature infants and demonstrated no difference in the incidence of adverse events. In respect to the route of administration, oral ibuprofen was as effective as intravenous indomethacin. When comparing both drugs via the intravenous route, the only difference noted between the ibuprofen and indomethacin was that ibuprofen was associated with a lesser increase in serum creatinine after treatment.

Conclusion: Ibuprofen and indomethacin are equally effective in PAD closure without any difference in the incidence of adverse events. Importantly, oral ibuprofen was as effective as intravenous indomethacin.

No MeSH data available.


Related in: MedlinePlus