Prophylaxis of patent ductus arteriosus with ibuprofen in preterm infants

The aim of our study was to evaluate whether the prophylactic use of ibupro fen would reduce the incidence of significant patent ductus arteriosus (PDA ) and to confirm the effectiveness of ibuprofen as rescue treatment in clos ing PDA. Eighty preterm infants with gestational age less than 34 wk with i nfant respiratory distress syndrome (iRDS) were randomized to receive intra venous ibuprofen lysine (10 mg/kg, followed by 5 mg/kg after 24 and 48 h) e ither within 24h of life (group A) or after echocardiographic diagnosis of FDA (group B). To evaluate the severity of RDS in each patient, we calculat ed the initial and highest values of Oxygenation Index (O.I. = mean airway pressure x FiO(2) x 100 / PaO2) and Ventilatory Index (V.I. = O.I. x mechan ical respiratory rate). Other studied variables were ventilatory support, r enal function, biochemical and haematological profiles, frequency of bronch opulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (:NEC) and retinopathy of prematurity (ROP). On the 3rd day of life, 8% (3/40) of patients of group A and 53% of patients (21/40) of gr oup B (p < 0.0001) developed a significant PDA. Between patients of group B who presented PDA at 3 d of life 90% (19/21) had a closure of ductus arter iosus after ibuprofen treatment. Initial and highest values of O.I. and V.I . were similar in both groups A and B. No significant differences between t he groups were observed in regard to respiratory support, renal function an d frequency of BPD, IVH, NEC and ROP. Ibuprofen was not associated with adv erse effects. Conclusion: Prophylactic treatment with ibuprofen reduces PDA occurrence in preterm infants with iRDS at 3 d of life in comparison with rescue treatme nt, but both modes are effective in closing the ductus without significant adverse effects.