Ibuprofen tied to decreased PDA rate among preterm/low-birth-weight infants

  • Ohlsson A & al.
  • Cochrane Database Syst Rev
  • 21 Jun 2019

  • International Clinical Digest
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Takeaway

  • Prophylactic ibuprofen is linked to reduced incidence of patent ductus arteriosus (PDA), according to the findings of this Cochrane meta-analysis, which updates an earlier report with some changes in conclusions.
  • Nevertheless, these authors conclude that the evidence does not support using ibuprofen to prevent PDA, in part because of no difference in mortality, chronic lung disease, or other outcomes.

Why this matters

  • Infants are exposed unnecessarily to a drug with important side effects and limited short-term benefits, say the authors, who note efforts to stratify risk in the first 72 hours of life using echocardiographic criteria. 

Key results

  • Ibuprofen was linked to decreased PDA risk on day 3/4:
    • Risk ratio, 0.39 (95% CI, 0.31-0.48; 9 trials; 1029 infants).
    • Number needed to treat: 4 (95% CI, 3-5).
  • Without intervention, 58% of infants had closure by day 3/4.
  • Ibuprofen also linked to reduced risk for needing rescue with cyclo-oxygenase inhibitors, surgical ductal ligation, possibly grade 3/4 intraventricular hemorrhage.
  • With ibuprofen prophylaxis, risk for oliguria increased:
    • Risk ratio, 1.45 (95% CI, 1.04-2.02).
    • Number needed to harm: 17.

Study design

  • Cochrane review, meta-analysis, 9 trials of prophylaxis vs placebo, no intervention, or indomethacin. 
  • Funding: Mount Sinai Hospital, Toronto, Ontario; Vermont Oxford Network.

Limitations

  • Those of included studies.