title: Comparison of oral and intravenous Ibuprofen for medical closure of patent ductus arteriosus: which one is better?
abstract: OBJECTIVE
  Intravenous ibuprofen is an expensive drug that is being used currently for treating and preventing patent ductus arteriosus. Although oral ibuprofen is much cheaper, there is limited data published about its safety and efficacy. The aim of this study was to compare two forms of ibuprofen in terms of safety and efficacy in closure of patent ductus arteriosus.
  
  
  METHODS
  This is a single-center retrospective study.
  
  
  METHODS
  Data were collected from patients' files of preterm infants who were hospitalized at the Neonatal Intensive Care Unit of Dr. Behcet Uz Children's Hospital between April 2009 and June 2010.
  
  
  METHODS
  Six hundred sixty infants were evaluated by echocardiography between 24 and 48 postnatal hours. Clinically and hemodynamically significant ductus arteriosus was defined in 66 infants with gestational age less than 32 weeks and birth weight less than 1500 g.
  
  
  METHODS
  Oral or intravenous ibuprofen (loading dose: 10 mg/kg on day 1, followed by maintenance dose: 5 mg/kg on days 2 and 3) was administered.
  
  
  METHODS
  Treatment success was defined as a completely closed duct without reopening on follow-up. Drug-associated renal, gastrointestinal, cerebral, hematological, and metabolic side effects were monitored and compared between treatment groups.
  
  
  RESULTS
  Ductal closure rates were 100% and 97.6%, respectively, in the oral and intravenous groups. Hypernatremia was the remarkable side effect in the intravenous group, whereas bronchopulmonary dysplasia and septicemia were prominent in the oral group. No statistically significant difference could be demonstrated between the groups in terms of mortality rates.
  
  
  CONCLUSIONS
  Oral ibuprofen therapy is as efficacious as intravenous ibuprofen with some concerns about increased sepsis and bronchopulmonary dysplasia incidence. However, comprehensive and large-scale pharmacokinetic studies are required in order to prove this efficacy. On the other hand, intravenous ibuprofen still remains to be the drug of choice for patent ductus arteriosus but only with meticulous control of serum sodium levels in smaller infants.
authors.affiliation: Neonatal Intensive Care Unit, Dr. Behcet Uz Children's Hospital, Izmir, Turkey. drolukman2002@yahoo.com
authors.forename: Ozgur
authors.initials: O
authors.lastname: Olukman
authors.forename: Sebnem
authors.initials: S
authors.lastname: Calkavur
authors.forename: Gulten
authors.initials: G
authors.lastname: Ercan
authors.forename: Fusun
authors.initials: F
authors.lastname: Atlihan
authors.forename: Taliha
authors.initials: T
authors.lastname: Oner
authors.forename: Vedide
authors.initials: V
authors.lastname: Tavli
authors.forename: Nilgun
authors.initials: N
authors.lastname: Kultursay
mesh_terms: D000284:Administration, Oral; D001997:Bronchopulmonary Dysplasia / Q000139:chemically induced; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced; D007052:Ibuprofen / Q000008:administration & dosage* / Q000009:adverse effects; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007275:Injections, Intravenous; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D014463:Ultrasonography
chemical_list: D007052:Ibuprofen