Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus.
Humans
Infant
Infant, Newborn
Bronchopulmonary Dysplasia
/ etiology
Ductus Arteriosus, Patent
/ diagnostic imaging
Echocardiography
Enterocolitis, Necrotizing
/ etiology
Ibuprofen
/ administration & dosage
Indomethacin
/ adverse effects
Infant, Extremely Premature
Infant, Low Birth Weight
Infant, Newborn, Diseases
/ drug therapy
Watchful Waiting
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
16 Mar 2023
16 Mar 2023
Historique:
pubmed:
9
12
2022
medline:
21
3
2023
entrez:
8
12
2022
Statut:
ppublish
Résumé
Cyclooxygenase inhibitors are commonly used in infants with patent ductus arteriosus (PDA), but the benefit of these drugs is uncertain. In this multicenter, noninferiority trial, we randomly assigned infants with echocardiographically confirmed PDA (diameter, >1.5 mm, with left-to-right shunting) who were extremely preterm (<28 weeks' gestational age) to receive either expectant management or early ibuprofen treatment. The composite primary outcome included necrotizing enterocolitis (Bell's stage IIa or higher), moderate to severe bronchopulmonary dysplasia, or death at 36 weeks' postmenstrual age. The noninferiority of expectant management as compared with early ibuprofen treatment was defined as an absolute risk difference with an upper boundary of the one-sided 95% confidence interval of less than 10 percentage points. A total of 273 infants underwent randomization. The median gestational age was 26 weeks, and the median birth weight was 845 g. A primary-outcome event occurred in 63 of 136 infants (46.3%) in the expectant-management group and in 87 of 137 (63.5%) in the early-ibuprofen group (absolute risk difference, -17.2 percentage points; upper boundary of the one-sided 95% confidence interval [CI], -7.4; P<0.001 for noninferiority). Necrotizing enterocolitis occurred in 24 of 136 infants (17.6%) in the expectant-management group and in 21 of 137 (15.3%) in the early-ibuprofen group (absolute risk difference, 2.3 percentage points; two-sided 95% CI, -6.5 to 11.1); bronchopulmonary dysplasia occurred in 39 of 117 infants (33.3%) and in 57 of 112 (50.9%), respectively (absolute risk difference, -17.6 percentage points; two-sided 95% CI, -30.2 to -5.0). Death occurred in 19 of 136 infants (14.0%) and in 25 of 137 (18.2%), respectively (absolute risk difference, -4.3 percentage points; two-sided 95% CI, -13.0 to 4.4). Rates of other adverse outcomes were similar in the two groups. Expectant management for PDA in extremely premature infants was noninferior to early ibuprofen treatment with respect to necrotizing enterocolitis, bronchopulmonary dysplasia, or death at 36 weeks' postmenstrual age. (Funded by the Netherlands Organization for Health Research and Development and the Belgian Health Care Knowledge Center; BeNeDuctus ClinicalTrials.gov number, NCT02884219; EudraCT number, 2017-001376-28.).
Sections du résumé
BACKGROUND
BACKGROUND
Cyclooxygenase inhibitors are commonly used in infants with patent ductus arteriosus (PDA), but the benefit of these drugs is uncertain.
METHODS
METHODS
In this multicenter, noninferiority trial, we randomly assigned infants with echocardiographically confirmed PDA (diameter, >1.5 mm, with left-to-right shunting) who were extremely preterm (<28 weeks' gestational age) to receive either expectant management or early ibuprofen treatment. The composite primary outcome included necrotizing enterocolitis (Bell's stage IIa or higher), moderate to severe bronchopulmonary dysplasia, or death at 36 weeks' postmenstrual age. The noninferiority of expectant management as compared with early ibuprofen treatment was defined as an absolute risk difference with an upper boundary of the one-sided 95% confidence interval of less than 10 percentage points.
RESULTS
RESULTS
A total of 273 infants underwent randomization. The median gestational age was 26 weeks, and the median birth weight was 845 g. A primary-outcome event occurred in 63 of 136 infants (46.3%) in the expectant-management group and in 87 of 137 (63.5%) in the early-ibuprofen group (absolute risk difference, -17.2 percentage points; upper boundary of the one-sided 95% confidence interval [CI], -7.4; P<0.001 for noninferiority). Necrotizing enterocolitis occurred in 24 of 136 infants (17.6%) in the expectant-management group and in 21 of 137 (15.3%) in the early-ibuprofen group (absolute risk difference, 2.3 percentage points; two-sided 95% CI, -6.5 to 11.1); bronchopulmonary dysplasia occurred in 39 of 117 infants (33.3%) and in 57 of 112 (50.9%), respectively (absolute risk difference, -17.6 percentage points; two-sided 95% CI, -30.2 to -5.0). Death occurred in 19 of 136 infants (14.0%) and in 25 of 137 (18.2%), respectively (absolute risk difference, -4.3 percentage points; two-sided 95% CI, -13.0 to 4.4). Rates of other adverse outcomes were similar in the two groups.
CONCLUSIONS
CONCLUSIONS
Expectant management for PDA in extremely premature infants was noninferior to early ibuprofen treatment with respect to necrotizing enterocolitis, bronchopulmonary dysplasia, or death at 36 weeks' postmenstrual age. (Funded by the Netherlands Organization for Health Research and Development and the Belgian Health Care Knowledge Center; BeNeDuctus ClinicalTrials.gov number, NCT02884219; EudraCT number, 2017-001376-28.).
Identifiants
pubmed: 36477458
doi: 10.1056/NEJMoa2207418
doi:
Substances chimiques
Ibuprofen
WK2XYI10QM
Indomethacin
XXE1CET956
Banques de données
ClinicalTrials.gov
['NCT02884219']
EudraCT
['2017-001376-28']
Types de publication
Equivalence Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
980-990Subventions
Organisme : Belgian Health Care Knowledge Centre
ID : 16013
Organisme : ZonMw
ID : 843002622
Pays : Netherlands
Investigateurs
Evangelia Papathanasiou
(E)
Martijn G Slieker
(MG)
Jörg Heuser
(J)
Mieke Roggen
(M)
Regina Bokenkamp
(R)
Laurens P Koopman
(LP)
Daniel de Wolf
(D)
Wendy Dewals
(W)
Kristof Vandekerckhove
(K)
Stefan Frerich
(S)
Frank A B A Schuerman
(FABA)
Sally-Ann B Clur
(SB)
G J du Marchie Sarvaas
(GJ)
Antoine Bondue
(A)
Hugues Dessy
(H)
Marijn J Vermeulen
(MJ)
Johan C A de Klerk
(JCA)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
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