Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Objective: To review intestinal complications associated with ibuprofen treatment of patent ductus arteriosus (PDA). Study Design: Data from preterm infants treated with ibuprofen were retrospectively reviewed. χ ² test and Fischer's exact test were used for univariate analyses. Multivariate analyses with logistic regression modeling were used to identify risk factors. Result: One hundred and two infants were treated with ibuprofen for PDA. Nine (9/102, 8.8%) infants developed spontaneous intestinal perforation (SIP), whereas 93/102 (91.2%) did not. The mean (±s.d.) gestational age (GA) at birth in infants with and without SIP was 25.2 (±1.3) vs 27.6 (±2.4) weeks (P=0.02) and the median (interquartile) length of stay (LOS) was 109.5 (91.0 to 116.5) vs 75.0 (53.0 to 94.5) days (P=0.002), respectively. The mean (±s.d.) age at starting ibuprofen was 3.3 (±1.3) vs 5.8 (±3.5) days in infants with and without SIP, respectively (P=0.03). In logistic regression analyses, increasing GA and later initiation of ibuprofen treatment were protective against risk of SIP; odds ratio, 95% confidence interval (OR, 95% CI)=0.26 (0.09 to 0.75), P=0.01 and 0.63 (0.41 to 0.95), P=0.03, respectively. Conclusion: Infants at lower GA are at risk of SIP when treated early with ibuprofen for symptomatic PDA.