title: 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.
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.
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hani
authors.identifier: http://orcid.org/0000-0002-9402-1499
authors.initials: H
authors.lastname: Yoo
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Boramae Medical Center, Seoul, Korea. ljinna@snu.ac.kr.
authors.forename: Jin A
authors.identifier: http://orcid.org/0000-0002-9194-0529
authors.initials: JA
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Sohee
authors.identifier: http://orcid.org/0000-0002-3010-448X
authors.initials: S
authors.lastname: Oh
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Young Hwa
authors.identifier: http://orcid.org/0000-0002-4159-586X
authors.initials: YH
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jin A
authors.identifier: http://orcid.org/0000-0002-4992-7128
authors.initials: JA
authors.lastname: Sohn
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung Han
authors.identifier: http://orcid.org/0000-0002-7008-4073
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Chang Won
authors.identifier: http://orcid.org/0000-0003-1911-0253
authors.initials: CW
authors.lastname: Choi
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ee Kyung
authors.identifier: http://orcid.org/0000-0002-7063-168X
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
authors.forename: Han Suk
authors.identifier: http://orcid.org/0000-0002-9777-3231
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.|Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Beyong Il
authors.identifier: http://orcid.org/0000-0003-0408-9279
authors.initials: BI
authors.lastname: Kim
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000209:etiology; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D004452:Echocardiography; D020345:Enterocolitis, Necrotizing / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D012189:Retrospective Studies; D012306:Risk
chemical_list: D020097:Natriuretic Peptide, Brain; D007052:Ibuprofen
keywords: Ibuprofen; Patent Ductus Arteriosus; Patient Outcome Assessment; Premature Infants; Treatment