Dual medication therapy (acetaminophen and ibuprofen) for the management of patent ductus arteriosus in preterm infants: a systematic review and meta-analysis

• Published in: Journal of perinatology Vol. 42; no. 12; pp. 1654 - 1661
• Main Authors: Shah, Sanket D., Makker, Kartikeya, Zhang, Mingyu, Harnett, Susan, Aziz, Khyzer B., Hudak, Mark L.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.12.2022; Nature Publishing Group
• Subjects: 631/443/592/75/1539; 692/699/75/1539; Acetaminophen; Analgesics; Clinical trials; Congenital diseases; Coronary vessels; Drug therapy; Ductus Arteriosus, Patent - drug therapy; Dysplasia; Enterocolitis; FDA approval; Gestational age; Humans; Ibuprofen; Ibuprofen - adverse effects; Ibuprofen - therapeutic use; Indomethacin; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infants; Librarians; Lung diseases; Medicine; Medicine & Public Health; Meta-analysis; Necrotizing enterocolitis; Neonates; Newborn babies; Nonsteroidal anti-inflammatory drugs; Pediatric Surgery; Pediatrics; Population studies; Premature babies; Renal function; Sepsis; Systematic review; Therapy
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-022-01500-8

Objective To examine the efficacy of dual medication therapy (intervention) (DMT: acetaminophen and ibuprofen) vs. single medication therapy (control) (SMT: ibuprofen) for medical management of PDA (outcomes) in preterm infants (population). Study design We systematically searched multiple sources to identify randomized controlled trials (RCT) and non-randomized studies (NRS) that compared DMT to SMT for management of hemodynamically significant PDA. Results We identified two RCTs and four NRS. There were no differences in the rates of successful PDA closure following the first treatment course between DMT and SMT (RR = 1.23 [95% CI 0.89–1.70] for NRS and RR = 1.18 [95% CI 0.66–2.10] for RCTs), nor were there significant differences in secondary outcomes and adverse events including PDA ligation, bronchopulmonary dysplasia, and necrotizing enterocolitis etc. Markers of hepatic/renal function did not change significantly during treatment. Conclusion We found no evidence for superiority of DMT over SMT in PDA management.