title: Efficacy of a first course of Ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight.
abstract: OBJECTIVE
  Therapeutic strategies for patent ductus arteriosus (PDA) in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA) newborns.
  
  
  METHODS
  This single-centre retrospective study included 185 infants born at 24+0-27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea): 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA) were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes.
  
  
  RESULTS
  The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2-12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3-70.5] p=0.003).
  
  
  CONCLUSIONS
  There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.
authors: Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France.
authors: Doriane
authors: D
authors: Madeleneau
authors: Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France.
authors: Marie-Stephanie
authors: MS
authors: Aubelle
authors: Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France.
authors: Charlotte
authors: C
authors: Pierron
authors: Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France.
authors: Emmanuel
authors: E
authors: Lopez
authors: Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France.
authors: Juliana
authors: J
authors: Patkai
authors: Department of Neonatal Medicine, Nantes University Hospital, Nantes, France.
authors: Jean-Christophe
authors: JC
authors: Roze
authors: Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France.
authors: Pierre-Henri
authors: PH
authors: Jarreau
authors: Department of Neonatal Medicine, Angers University Hospital, Angers, France.
authors: Geraldine
authors: G
authors: Gascoin
mesh_terms: D000367:Age Factors; D001724:Birth Weight; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007230:Infant, Low Birth Weight / Q000254:growth & development*; D007231:Infant, Newborn; D008297:Male; D015233:Models, Statistical; D012189:Retrospective Studies
chemical_list: D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen