What is the recommended dose of ibuprofen (nonsteroidal anti-inflammatory drug) for treating patent ductus arteriosus (PDA)?

Ibuprofen Dosing for Patent Ductus Arteriosus (PDA) Treatment

The recommended dosing regimen for ibuprofen in treating patent ductus arteriosus (PDA) in infants is an initial dose of 10 mg/kg followed by two doses of 5 mg/kg given at 24-hour intervals. 1

Dosing Protocol for PDA Closure

• Ibuprofen is administered intravenously for PDA closure in premature infants using a 3-dose regimen 1:

  • Initial dose: 10 mg/kg
  • Second dose: 5 mg/kg (given 24 hours after initial dose)
  • Third dose: 5 mg/kg (given 24 hours after second dose)

• This regimen should be initiated after confirming PDA diagnosis through echocardiography and determining that pharmacological closure is appropriate 1

• Ibuprofen therapy should be considered for infants with established bronchopulmonary dysplasia (BPD) and symptomatic PDA after optimal treatment of underlying respiratory and cardiac disease 1

Clinical Considerations and Monitoring

• Serial echocardiograms are recommended to monitor the response to ibuprofen therapy in infants with PDA 1

• Before initiating ibuprofen therapy, a comprehensive evaluation including cardiac catheterization is recommended to assess disease severity and potential contributing factors such as LV diastolic dysfunction, anatomic shunts, pulmonary vein stenosis, and systemic collaterals 1

• Supplemental oxygen therapy should be maintained to avoid hypoxemia, with a goal of maintaining O₂ saturations between 92% and 95% in patients with established BPD and PH 1

Contraindications and Precautions

• Ibuprofen should be used cautiously in infants with:

  • Renal dysfunction
  • Active bleeding (especially intracranial or gastrointestinal)
  • Thrombocytopenia
  • Coagulopathy
  • Necrotizing enterocolitis 1

• NSAIDs including ibuprofen should be discontinued after gestational week 28 in pregnant women due to the risk of premature closure of the ductus arteriosus in the fetus 2

• Ibuprofen should not be administered if the infant has significant renal impairment 1

Alternative Therapies

• Indomethacin is an alternative NSAID that can be used for PDA closure, though it may have a higher risk of renal and gastrointestinal side effects compared to ibuprofen 1

• For infants with severe PH who do not respond to medical therapy, ECMO (extracorporeal membrane oxygenation) may be recommended 1

• Prostaglandin E1 may be considered to maintain patency of the ductus arteriosus in specific conditions such as congenital heart disease with systemic outflow obstruction 1

Monitoring During Treatment

• Monitor renal function before and during treatment 1

• Assess for signs of bleeding or bruising 1

• Perform serial echocardiograms to evaluate PDA closure response 1

• Monitor for signs of necrotizing enterocolitis, as NSAIDs may increase this risk 1