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

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...

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Bibliographic Details
Published in:European journal of pediatrics 2005-03, Vol.164 (3), p.135-140
Main Authors: THOMAS, Ronald L, PARKER, Graham C, VAN OVERMEIRE, Bart, ARANDA, Jacob V
Format: Article
Language:English
Subjects:
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Biological and medical sciences
Blood
Cardiology. Vascular system
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Creatinine
Creatinine - blood
Ductus Arteriosus, Patent - drug therapy
General aspects
Heart
Hemorrhage
Humans
Hypotheses
Ibuprofen - therapeutic use
Indomethacin - therapeutic use
Infant, Newborn
Infant, Premature
Length of stay
Lung diseases
Medical sciences
Meta-analysis
Mortality
Newborn babies
Nonsteroidal anti-inflammatory drugs
Oxygen Inhalation Therapy - statistics & numerical data
Oxygen therapy
Pediatrics
Premature babies
Randomized Controlled Trials as Topic
Sepsis
Surfactants
Urination
Urine
Ventilators
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Summary: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. 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.
ISSN:0340-6199
1432-1076
DOI:10.1007/s00431-004-1596-5