Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Objective: To review intestinal complications associated with ibuprofen treatment of patent ductus arteriosus (PDA). Study Design: Data from preterm infants treated with ibuprofen were retrospectively reviewed. chi(2) test and Fischer's exact test were used for univariate analyses. Multivariate analyses with logistic regression modeling were used to identify risk factors. Result: One hundred and two infants were treated with ibuprofen for PDA. Nine (9/102, 8.8%) infants developed spontaneous intestinal perforation (SIP), whereas 93/102 (91.2%) did not. The mean (+/- s.d.) gestational age (GA) at birth in infants with and without SIP was 25.2 (+/- 1.3) vs 27.6 (+/- 2.4) weeks (P=0.02) and the median (interquartile) length of stay (LOS) was 109.5 (91.0 to 116.5) vs 75.0 (53.0 to 94.5) days (P=0.002), respectively. The mean (+/- s.d.) age at starting ibuprofen was 3.3 (+/- 1.3) vs 5.8 (+/- 3.5) days in infants with and without SIP, respectively (P=0.03). In logistic regression analyses, increasing GA and later initiation of ibuprofen treatment were protective against risk of SIP; odds ratio, 95% confidence interval (OR, 95% CI) = 0.26 (0.09 to 0.75), P=0.01 and 0.63 (0.41 to 0.95), P=0.03, respectively. Conclusion: Infants at lower GA are at risk of SIP when treated early with ibuprofen for symptomatic PDA. Journal of Perinatology (2011) 31, 465-470; doi: 10.1038/jp.2010.199; published online 20 January 2011