214 Early Versus Symptomatic Treatment for Patent Ductus Arteriosus (PDA) with Ibuprofen in Preterm Infants

Background: Timing to indicate pharmacological PDA closure is controversial and varies widely among NICUs. Aims: To assess whether early versus symptomatic treatment of PDA could affect failure rate and need for surgery. Methods: Between May 2009 and March 2010, infants < 29 wks or < 1000 g, and those with 29-33 wks and respiratory distress syndrome, underwent echocardiography within the first 72 hours of postnatal life, and received ibuprofen if PDA ≥1.5 mm (study group). A historic cohort (May 2008 to March 2009) consisting on infants with symptomatic PDA that received ibuprofen was used as control group. The primary outcomes were PDA closure failure rate and need for surgery. Non-parametric tests were used for comparisons. Results: 88 infants were included, the study group [n= 38; gestational age 28.7 (2.4) wk; birth weight 1121 (338) g] and the control group [n=50; gestational age 28.3 (2.1) wk; birth weight 1032 (336) g] being comparable with respect to main perinatal data. Trends towards lower failure rate (26.3% vs 40%) and need for surgery (21.1 vs 32%) were found in the study and control group, respectively, although not significant. Onset of ibuprofen treatment (p< 0.000), number of administered doses (p=0.001) and days to reach total enteral nutrition (p<.05) were significantly lower in the study group. Other clinical outcomes did not differ. Conclusions: Early treatment with ibuprofen seems to report benefits without additional side effects.