The Impact of an Early Ibuprofen Treatment Protocol on the Incidence of Surgical Ligation of the Ductus Arteriosus

This study sought to determine whether early treatment of premature infants with ibuprofen would result in a reduced incidence of surgical ligation of patent ductus arteriosus. Secondary outcomes included duration of hospitalization, assisted ventilation and supplemental oxygen, mortality rate, persistent patent ductus arteriosus (PDA), hypotension, intraventricular hemorrhage, and intestinal perforation. Outcomes among 105 very low-birth-weight (VLBW) infants managed by clinical use of indomethacin were compared with outcomes of 80 infants treated under a standardized protocol for ibuprofen therapy on the first day of life among infants <25 weeks estimated gestational age (EGA) and among infants of 25 to 28 weeks EGA with respiratory distress syndrome or history of antenatal steroids. The incidence of PDA ligation was significantly lower among the early ibuprofen group than among the clinical indomethacin group (0/80 versus 9/105, p = 0.0056). No differences were found in secondary outcomes. The effect persisted (p = 0.0100 to 0.0153) when corrected for birth weight, EGA, gender, Apgar scores, initial pH and base deficit, transport from another hospital, surfactant treatment, and need for assisted ventilation. In our neonatal intensive care unit, the incidence of PDA ligation among VLBW infants decreased after adoption of an early ibuprofen treatment protocol.