Treatment | Comments | |
---|---|---|
Ibuprofen IV | Prophylaxis: 10 mg/kg followed by 5 mg/kg at 24 and 48 h | Administer after the first 6 h of life. The final dose need not be given if the duct is closed on echocardiographic review after the second dose. |
Symptomatic: 10 mg/kg followed by 5 mg/kg at 24 and 48 h | Should the duct remain open after the third dose, continue with fourth and fifth doses of 5 mg/kg to be given 24 and 48 h after the third dose. If there is absolutely no response after one course, or failure to close after an extended course, further PGHS treatment is frequently ineffective. | |
Ibuprofen enteral (20 mg/mL)* | Symptomatic: 10 mg/kg followed by 5 mg/kg at 24 and 48 h | Should the duct remain open after the third dose, continue with fourth and fifth doses of 5 mg/kg to be given 24 and 48 h after the third dose. If there is absolutely no response after one course, or failure to close after an extended course, further PGHS treatment is frequently ineffective. |
Indomethacin IV† | Prophylaxis: 0.2 mg/kg followed by 0.1 mg/kg at 12, 24 and 48 h | The final dose need not be given if the duct is closed on echocardiographic review after the second dose. |
Early symptomatic: (2–6 days) 0.2 mg/kg followed by 0.1 mg/kg at 12, 24 and 48 h | Should the duct remain open after the fourth dose, continue with fifth and sixth doses of 0.1 mg/kg to be given 24 and 48 h after the fourth dose. If there is absolutely no response after one course, or failure to close after an extended course, further PGHS treatment is frequently ineffective. | |
Late symptomatic: (>7 days) 0.2 mg/kg at 0, 12, 24 and 48 h | Should the duct reopen after one course, a further course may be worthwhile and would be recommended before referral for PDA ligation. If there is absolutely no response after one course, or failure to close after an extended course, further PGHS treatment is frequently ineffective. |
Neither drug should be administered in the presence of renal impairment, thrombocytopenia and/or active bleeding problems. Caution should be exercised in infants with postnatal corticosteroid treatment or hypotension.
*As per enteral ibuprofen trials. Commercial preparations are hyperosmolar and should be followed by 2 mL/kg of water or milk. This is not a licensed indication.
†Indomethacin should always be infused over at least 30 min.
PDA, patent ductus arteriosus; PGHS, prostaglandin H2 synthetase.