PDA treatment - indo vs ibuprofen

[manuel perez valdez]

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

[Alexander Rakow]

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.

[sbarak]

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.

[Mariam]

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

[hehady]

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.

[neha]

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

[sjbrott]

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

[drprasadrao]

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