A Second Course of Ibuprofen Is Effective in the Closure of a Clinically Significant PDA in ELBW Infants

OBJECTIVES: There are few published data on the efficacy of ibuprofen in the most immature infants and no data on repeated courses. Our objectives were to describe PDA closure rates in a population of infants < 1000 g birth weight after repeated courses of ibuprofen, to examine the effect of gestation, and to document plasma markers of renal function and platelet counts. METHODS: This was a single center observational study. We collected data on infants weighing < 1000 g at birth who were treated with ibuprofen for a clinically significant PDA. A successful outcome was defined as resolution of clinical symptoms such that no additional treatment was required. Serum biochemistry and hematology data were analyzed and compared with controls. RESULTS: We identified 160 infants with a mean +/- SD birth weight of 757 +/- 127 g and gestation of 25.6 +/- 1.4 weeks. Seventy infants closed their PDA after a single course of ibuprofen (45%) and 32/80 (40%) following a second. Infants of < 26 weeks' gestation (n = 83) were less likely to respond after both the first (27.7% vs 63.6%; P < .001) and second (30.9% vs 60.0%; P = .026) courses. The postnatal decrease in plasma creatinine was delayed by ibuprofen treatment, while platelet counts and other plasma markers were unaffected. CONCLUSIONS: In our study population, PDA closure was gestation dependant, with a cumulative closure rate of 65%. A similar proportion of infants closed their PDA following the first and second courses regardless of gestation. These data suggest that a second course of ibuprofen may be effective in closing a PDA in even the most preterm infant. Pediatrics 2009;124:e287-e293