Meta-analysis of the effect of intravenous prophylactic ibuprofen on prevention of patent ductus arteriosus in preterm infants / 中华围产医学杂志

ABSTRACT

Objective To determine the effectiveness and safety of prophylactic intravenous ibuprofen compared to placebo/no intervention on the prevention of patent ductus arteriosus(PDA) in preterm infants.Methods Randomized controlled trials(RCT) or quasi-RCT comparing prophylactic intravenous ibuprofen versus placebo/no treatment for prevention of PDA in preterm infants were enrolled. The standard search strategy included electronic search and manual search. Electronic search was carried out in databases including PubMed,ScienceDirect, EMBASE, OVID, Cochrane Library, VIP Chinese Periodical Database and Chinese Digital Hospital Library (www. chkd. cnki. net) without language restriction. As a supplementation,references in previous reviews and studies identified as relevant had been examined by manual search. RevMan 5.0. 21 was used in the statistical analysis. Effects were expressed as weighted mean difference (WMD) and 95% confidence interval (CI) for continuous data while risk ratio (RR) and 95%CI for categorical data.Results Four studies qualified for this meta-analysis including three graded 4 and one graded 3 with Jadad scale. Prophylactic use of ibuprofen significantly decreased the incidence of PDA on day three (RR=0. 40,95 % CI 0. 31-0. 51, P＜0.01 ), the need for rescue treatment with cyclo-oxygenase inhibitors (RR = 0. 18,95 % CI0. 07-0. 45, P = 0. 0003) and the need for surgical ligation (RR = 0. 34,95 % CI 0. 14-0. 81, P =0. 02) in the prophylactic group. No significant difference of pulmonary, cerebral, gastrointestinal, and renal complications were found between the prophylactic and control groups. Conclusions Prophylactic intravenous ibuprofen significantly reduces the risk of PDA on day three, decreases the need for rescue treatment with cyclo-oxygenase inhibitors and surgical ligation without significant pulmonary, cerebral,gastrointestinal, and renal complications were seen in the prophylactic group. Due to the limits of evidences to date, prophylactic ibuprofen intravenously for prevention of PDA in preterm infants is not recommended.