Elsevier

The Journal of Pediatrics

Volume 135, Issue 6, December 1999, Pages 733-738
The Journal of Pediatrics

Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus,☆☆

https://doi.org/10.1016/S0022-3476(99)70093-4Get rights and content

Abstract

Objective: To evaluate the effect of intravenous ibuprofen and indomethacin for treatment of patent ductus arteriosus (PDA) on mesenteric and renal blood flow velocity in preterm infants. Study design: Seventeen mechanically ventilated preterm infants (<33 weeks’ gestation) with PDA received either 0.2 mg/kg indomethacin (n = 8) or 10 mg/kg ibuprofen (n = 9), infused over 15 minutes. Mesenteric and renal blood flow velocity were measured by using Doppler ultrasonography. Results: Indomethacin caused a significant reduction in mesenteric and renal blood flow velocity 30 minutes after drug administration; mesenteric and renal blood flow velocity did not return to the pretreatment values by 120 minutes. Ibuprofen did not alter blood flow 30 minutes after treatment, and blood flow increased 120 minutes after treatment. Mesenteric and renal blood flow velocity changes were significantly different between the 2 treatment groups. Conclusions: Compared with indomethacin, ibuprofen did not significantly reduce mesenteric and renal blood flow velocity.(J Pediatr 1999;135:733-8)

Section snippets

PATIENTS AND METHODS

We studied a group of 17 preterm infants <33 weeks’ gestational age, who were receiving mechanical ventilation because of respiratory distress syndrome and had evidence of hemodynamically significant PDA on the second day of life. Infants were excluded if they had malformations, renal or gastrointestinal abnormalities, hypotension or hypertension, infection, anemia (hemoglobin <10 g/dL), polycythemia (venous hemoglobin >22 g/dL), platelet count <50,000/mm3, or intraventricular hemorrhage of

RESULTS

There were no significant differences in birth weight, gestational age, amount of feeding, or postnatal age at the start of therapy (Table).

Table. Characteristics of the study population at entry

VariablesIndomethacin (n = 8)Ibuprofen (n = 9)P value
Birth weight (g)1277 ± 440 (630-1890)1151 ± 426 (580-1810)NS
Gestational age (wk)29.5 ± 2.6 (26- 32)29.1 ± 2.1 (26-32)NS
Age at treatment (h)33.2 ± 5.4 (26-42)31.9 ± 4.5 (27-40)NS
FIO 2 (%)39.7 ± 8.8 (28-55)38.5 ± 8.0 (29-54)NS
MAP (cm H2O)8.8 ± 1.3

DISCUSSION

Indomethacin has been the drug of choice for the treatment of PDA, but significant reductions in cerebral, mesenteric, and renal perfusion have been reported.6, 7, 8, 9, 10 A continuous infusion of indomethacin over 24 hours minimized the reduction of cerebral perfusion.4 More recently, ibuprofen was used with the same efficacy to close the duct and was associated with fewer side effects.14, 26, 27 In comparison with indomethacin, ibuprofen did not reduce cerebral BFV in preterm human infants.12

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  • Cited by (0)

    Reprint requests: Marco Pezzati, MD, Division of Neonatology, Careggi University Hospital, Viale Morgagni 85, 50134 Firenze, Italy.

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