Ibuprofen. PO

[Guest jammaltaleb]

Hi all

Does somebody have an experience with ibuprofen ,I mean PO, for closure PDA?

Do you give ibuprofen PO when baby NPO?

Which dilution do you use and do you give bolus or by gavage ?

Which protocole do you use.?

Thanks

[gopan2596]

Hi

We regulary use oral Ibuprofen for PDA closure . The cochrane review has also concluded that oral Ibuprofen is equally efficacious as Indomethacin , and had favourable profile on renal function and on gut ( lesser incidence of NEC . We give it at 10 mg / kg on day 1 and then 5 mg / kg for two more doses at 24 hours interval . We have found excellent results with the same . Oral preparation is available as a suspension and could be given by ryles tube . I think the baby is generally NPO regardless when we decide to treat PDA in the neonatal period . Late admin has limited success , in which case the baby is best kept NPO and then feeds started later once clinical condition is satisfactory .

Hope this helps

Regards

Gopan

[Stefan Johansson]

Here - a new publication comparing PO and IV ibuprofen, published yesterday in ADC. I paste part of the abstract below

http://fn.bmj.com/content/early/2011/12/05/archdischild-2011-300532.abstract

Design Prospective, randomised controlled study.

Patients and interventions The study enrolled 80 preterm infants with gestational age ≤28 weeks, birth weight <1000 g, postnatal age 48 to 96 h, and had echocardiographically confirmed significant PDA. Seventy extremely low birthweight (ELBW) preterm infants received either intravenous or oral ibuprofen randomly as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h.

Results PDA closure rate was significantly higher with oral ibuprofen (83.3% vs 61.7%) after the first course of the treatment (p=0.04). Although the primary closure rate was marginally higher in the oral ibuprofen group, the need for a second course of ibuprofen during the whole hospitalisation was similar between groups: 11 of 36 in oral versus 15 of 34 in intravenous groups (p=0.24) because of a higher reopening rate in the oral group. In addition to no increase in side effects with oral ibuprofen use, the need for postnatal steroid use for chronic lung disease was significantly lower in oral ibuprofen group (p=0.001).

[Francesco Cardona]

Interestingly - they found that more "closed" ducts reopened in the oral group though. there was also no mentioning if children differed related to respiratory status at time of randomisation or ongoing infection - two important variables that affect efficiency of closure.

Interestingly they were convinced a priori that oral ibuprofen would be better than iv. ibuprofen and powered their study accordingly -i wonder what studies were the basis for that.

Most important though: if your goal is closing of the duct, both routes of administration seem to be possible

Another similar study from Ankara, turkey

http://www.ncbi.nlm.nih.gov/pubmed/21094951

very similar results, too!

OBJECTIVE:

To compare oral ibuprofen with intravenous ibuprofen for closure of patent ductus arteriosus in very low birth weight (VLBW) preterm infants.

STUDY DESIGN:

In a prospective, randomized study, 102 VLBW preterm infants with patent ductus arteriosus received either intravenous or oral ibuprofen at an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 hours. The success rate and evaluation of renal tolerance using cystatin-C were the major outcomes.

RESULTS:

Patent ductus arteriosus closure rate was significantly higher with oral ibuprofen (84.6% versus 62%) after the first course of the treatment (P = .011). The cystatin-C level increased significantly after treatment in the oral group (P = .001), but did not change with intravenous ibuprofen (P = .4).

Edited December 8, 2011 by fcardona
added 2nd study

[selvanr4]

gives us a good alternate to indomethacin capsule crushing and diluting with sterile water 3 times.

thanks

selvan