J Korean Med Sci.  2017 Jan;32(1):115-123. 10.3346/jkms.2017.32.1.115.

Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment

• Yoo H
• Lee JA
• Oh S
• Jung YH
• Sohn JA
• Shin SH
• Choi CW
• Kim EK
• Kim HS
• Kim BI

• KMID: 2417593
• DOI: http://doi.org/10.3346/jkms.2017.32.1.115

Abstract

The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with < 28 weeks of gestation who received ibuprofen treatment according to the presence of clinical symptoms (any of oliguria, hypotension, or moderate to severe respiratory difficulty) attributable to hemodynamically-significant patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23-27] vs. 26 [23-27] weeks; P = 0.012) and lighter (655 [500-930] vs. 880 [370-1,780] grams; P < 0.001). Also, the clinical risk index for babies (CRIB)-II scores were higher and more infants received invasive ventilator care ≤ 2 postnatal days. More infants received multiple courses of ibuprofen in clinical symptoms group. Although the frequency of secondary patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ≤ 2 postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent.

Keyword

Patent Ductus Arteriosus; Premature Infants; Treatment; Ibuprofen; Patient Outcome Assessment

MeSH Terms

Bronchopulmonary Dysplasia
Ductus Arteriosus, Patent*
Enterocolitis, Necrotizing
Hemorrhage
Humans
Hypotension
Ibuprofen*
Incidence
Infant
Infant, Newborn
Infant, Premature*
Ligation
Logistic Models
Mortality*
Oliguria
Parturition
Patient Outcome Assessment
Pregnancy
Ventilators, Mechanical
Ibuprofen

Figure

• 

  Fig. 1 Flow chart of the study population. A total of 91 infants with < 28 weeks of gestation born between April 2010 and March 2015 with hemodynamically-significant patent ductus arteriosus (hsPDA) receiving ibuprofen treatment were included in the analysis. Infants with hsPDA without clinical symptoms were 77 infants (84.6%) and infants with hsPDA with clinical symptoms were 14 infants (15.4%) at the time of first ibuprofen treatment. PDA = patent ductus arteriosus.

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