Outcome Of Two Prophylactic Treatment Choices For Patent Ductus Arteriosus In A Neonatal Intensive Care Unit

Abstract

Prophylactic treatment of patent ductus arteriosus (PDA) in premature infants with indomethacin (INDO) or ibuprofen (IBU) has been shown to be effective in decreasing rescue medical and surgical treatment rates. However, routine use of prophylactic treatment remains controversial due to potential for adverse effects from the pharmacologic treatment. We compared the outcome and adverse effects of three different PDA treatment practices used sequentially in a level 3C neonatal intensive care unit (NICU). We conducted a retrospective case control study on infants born at less than 28 weeks gestational age between January 2005 and September 2009. We compared PDA prophylactic treatment with INDO (n=20) and IBU (n=60) to a control group of no prophylactic treatment (n=59). There was a statistically significant decrease in the frequency of PDA rescue treatment associated with both methods of PDA prophylaxis (p <0.0001, control 63%, INDO 20%, IBU 17 %). The rate of PDA ligation decreased significantly only in the comparison of IBU to control (p=0.04) (control 27%, INDO 30%, IBU 12%). The frequency of any intestinal perforation was significantly higher only in the INDO group (p=0.03) compared to the control group, (control 8%, INDO 30%, IBU 15%).Results illustrate how a choice of a prophylactic pharmacologic agent for PDA can alter outcomes (in this case the incidence of perforation) in an individual NICU.