Effectiveness of Ibuprofen Arginine, Ibuprofen Lysine, and Indomethacin for Patent Ductus Arteriosus Closure in Neonates.

Abstract

Objective: Given the limited data on the use of ibuprofen arginine for the closure of patent ductus arteriosus (PDA), this study aims to retrospectively assess PDA closure rates and the safety profile of ibuprofen arginine as compared with ibuprofen lysine and indomethacin in neonates across a multicenter hospital system.

Methods: This retrospective cohort study included neonates with symptomatic PDA admitted between July 2021 and August 2023, who received at least 1 dose of injectable indomethacin, ibuprofen lysine, or ibuprofen arginine. The primary aim was to compare closure rates of the PDA during the initial course of pharmacologic therapy. Secondary outcomes included the failure of therapy necessitating a repeat course or surgical ligation and adverse effects such as gastrointestinal bleeding, acute kidney injury, necrotizing enterocolitis, chronic lung disease, and intraventricular hemorrhage.

Results: A total of 54 patients were included in the analysis; 26 received indomethacin, 13 received ibuprofen lysine, and 15 received ibuprofen arginine. There was no significant difference among groups in terms of closure rates after 1 course (53% indomethacin, 39% ibuprofen lysine, and 47% ibuprofen arginine; p = 0.66). Similarly, no differences were found in the need for a repeat course (35% indomethacin, 54% ibuprofen lysine, and 53% ibuprofen arginine; p = 0.29) or surgical ligation. Adverse effects rates were comparable across the groups.

Conclusions: Indomethacin, ibuprofen lysine and ibuprofen arginine can all be considered viable options for pharmacologic closure of PDA in this population. Future prospective studies are needed to confirm these results and optimize patient outcomes.