title: Continuous infusion of ibuprofen for treatment of patent ductus arteriosus in very low birth weight infants.
abstract: BACKGROUND
  Ibuprofen (IBU) has proved as effective as indomethacin in the pharmacological closure of hemodynamically significant patent ductus arteriosus (HsPDA), with an efficacy inversely related to gestational age (57-89%).
  
  
  OBJECTIVE
  This study aimed to establish whether continuous infusions of IBU could be more effective in very low birth weight infants with no additional adverse effects and reduce the need for surgical ligation.
  
  
  METHODS
  A prospective, randomized, double-dummy study was conducted on 112 very low birth weight infants (mean gestational age 27.2 weeks, SD 2; birth weight 1,019 g, SD 330) with HsPDA, 56 of whom were given IBU in conventional 15-min intermittent boluses, while the other 56 were administered IBU as a 24-hour continuous infusion, both at standard doses (10/5/5 mg/kg). Extensive echocardiography was performed before and after treatment, and adverse effects were monitored.
  
  
  RESULTS
  Pharmacological PDA closure was achieved after 1 or 2 IBU courses in 36 of 56 infants (64.3%) after bolus administration and in 46 of 55 (83.6%) after continuous infusion (p = 0.020), and in 9 of 26 (34.6%) and 24 of 30 (80.0%), respectively, in the infants with a gestational age of 23-27 weeks (p = 0.006). Sustained pharmacological closure was observed in 38 of 56 infants (67.9%) after bolus IBU and in 47 of 55 (85.5%) after continuous infusion (p = 0.029). Surgical ligation was used less after continuous infusion than after bolus IBU (5.5 vs. 19.6%; p = 0.024). The continuous infusion group had fewer symptoms of necrotizing enterocolitis (NEC), especially in the more preterm infants, while other neonatal morbidity and mortality rates were similar.
  
  
  CONCLUSIONS
  Continuous IBU infusion is more effective than standard boluses for sustained closure of HsPDA, with fewer NEC symptoms and less need for surgical ligation in very low birth weight infants.
authors.affiliation: Neonatal Intensive Care Unit, Department of Women's and Children's Health, Azienda Ospedaliera-University of Padua, Padua, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Lago
authors.forename: Sabrina
authors.initials: S
authors.lastname: Salvadori
authors.forename: Francesca
authors.initials: F
authors.lastname: Opocher
authors.forename: Silvia
authors.initials: S
authors.lastname: Ricato
authors.forename: Lino
authors.initials: L
authors.lastname: Chiandetti
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
mesh_terms: D004311:Double-Blind Method; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D004452:Echocardiography; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D007052:Ibuprofen