Worse outcomes of early targeted ibuprofen treatment compared to expectant management of patent ductus arteriosus in extremely premature infants

Abstract

Aims: The aim of the study is to evaluate two different patent ductus arteriosus (PDA) management approaches and their impact on neonatal mortality and/or bronchopulmonary dysplasia (BPD) and 2-year outcomes. Subjects and Methods: For two consecutive periods, data on early mortality and morbidity were obtained retrospectively, while long-term morbidity data in children born before 28 weeks of gestation were collected prospectively. In the early targeted treatment period (TTP), ibuprofen was early indicated on patients with high clinical risk and PDA diameter of more than two millimeters in the first 3 days. In the expectant treatment period (EXP), the expectant approach was used. Results: A total of 201 eligible infants were screened. Of these, 99 were managed in the TTP and 102 in the EXP. From 99 infants in the TTP, 24 patients were treated early and 17 later. From 102 infants in the EXP, 17 infants with symptomatic PDA were treated. Severe BPD and/or death were more frequent in the TTP as compared to EXP (28 and 16 infants, respectively; P = 0.007; odds ratio = 2.12; confidence interval = 1.06–4.23; c = 0.216). Moreover, infants who underwent the expectant approach did not need further cardiological interventions after discharge. Conclusions: Early targeted treatment of large PDAs was associated with an increased risk of severe BPD and/or death. We must pay attention to the side effects of early ibuprofen treatment because these may outweigh the benefits of ductus closure, especially in the vulnerable population of extremely preterm infants.