i want to know about the use of indomethacine vrs iboprufen on PDA treatment

We have used ibuprofen (iv) since 2001 and have good experience. Ibuprofen is not a wonder drug, efficacy is the same as for indo (as shown also in the cochrane report) but there are less renal function impairment, which is one advantage.

We start treating PDA by fluid restrictio.In case it's not successful and PDA

effect the baby's condition ,we consider all risk factors,ECHO & laboratory tests and start indomethacin treatment.

I don't used ibuprofen in my practice.

We dont use Ibuprofen in our practice. However I have done a seminar about the use of Ibuprofen for the treatment of PDA. all RCT concluded that IBU & INDO have similar efficacy on PDA, but infants treated with IBU experience lower serum creatinine values, higher urine output, and less undesirable decreased organ blood flow and vaso-constrictive adverse effects. I can send the links of the articles if anyone is interested

IV form of Ibuprofen is expensive, not available in my country. We sometimes use oral ibuprofen.

There are quiet few studies on that issue like:

1: Chotigeat U, Jirapapa K, Layangkool T. A comparison of oral ibuprofen and intravenous indomethacin for closure of patent ductus arteriosus in preterm infants.J Med Assoc Thai. 2003 Aug;86 Suppl 3:S563-9.

2: Heyman E, Morag I, Batash D, Keidar R, Baram S, Berkovitch M.

Closure of patent ductus arteriosus with oral ibuprofen suspension in premature newborns: a pilot study. Pediatrics. 2003 Nov;112(5):e354.

3: Hariprasad P, Sundarrajan V, Srimathy G, Suthagar B, Ramadevi BS.

Oral ibuprofen for closure of hemodynamically significant PDA in premature

neonates. Indian Pediatr. 2002 Jan;39(1):99-100.

But be ware of the reported complication of spontaneous intestinal perforation (we have not experienced it) but other had:

Tatli MM, Kumral A, Duman N, Demir K, Gurcu O, Ozkan H. Spontaneous intestinal perforation after oral ibuprofen treatment of patent ductus arteriosus in two very-low-birthweight infants.

Acta Paediatr. 2004 Jul;93(7):999-1001.

We have been using Indomethacin in my unit for last 10years. On confirmation of a significant PDA we restrict the fluid and give diuretics in low dose. Even PDA of 3 mm size has closed with this treatment. If favourable like normal renal function and normal platelet counts with no IVH Indomathacin we give without hesitation if ECHO shows a hemodynamically significant PDA. On two occasions with low plateletas PDA was complicating the scenario so much that we gave platelet and used indomethacin to successfully close the PDA.

I have used Ibuprofen while working in UK. My personal experience is that Indomethacin can be safely used in Prems with significant PDA after a trial of fluid restriction and diuretics.

Dr Suresh Chandran

Consultant Neonatologist

RIPAS Hospital

Brunei Darussalam

In April 2006 the US FDA approved ibuprofen lysine for closing a PDA in premies between 500-1500gms with good results.

We have been using oral ibruprofen in our neonates with good results till date