To evaluate the effect of minimal enteral feeding (MEN) versus withholding feeding on time to reach full feeds during treatment of hs-PDA with oral ibuprofen in infants ≤30 weeks.
We performed a single-center, randomized control trial of 126 premature infants born ≤30 weeks gestation, <7 days of age with hs-PDA comparing continuation of MEN (n = 64) vs no feeding (n = 62) during treatment. The primary outcome was time to reach a feed volume of 150 ml/kg/day. Secondary outcomes included were episodes of feed intolerance, GI bleed, NEC and other comorbidities.
There was no difference in the time to reach full feeds - median age of 16 days in both groups (p = 0.573). Incidence of feed intolerance, NEC and other secondary outcomes were also similar in both groups.
Continuing MEN during treatment of hs-PDA with oral ibuprofen does not decrease time to reach full enteral feeds in very preterm infants.
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Dice JE, Bhatia J. Patent ductus arteriosus: an overview. J Pediatr Pharm Ther. 2007;12:138–13846.
Nemri AM. Patent ductus arteriosus in preterm infant: basic pathology and when to treat. Sudan J Paediatr [Internet]. 2014;14:25–30.
Khazaeinia T, Jamali F. Evaluation of gastrointestinal toxicity of ibuprofen using surrogate markers in rats: effect of formulation and route of administration. Clin Exp Rheumatol. 2000;18:187–92.
Clyman R, Wickremasinghe A, Jhaveri N, Hassinger DC, Attridge JT, Sanocka U, et al. Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus. J Pediatr. 2013;163:1–10.
Arlettaz R. Echocardiographic evaluation of patent ductus arteriosus in preterm infants. Front Pediatr. 2017;5:1–9.
Kluckow M, Jeffery M, Gill A, Evans N. A randomised placebo-controlled trial of early treatment of the patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed. 2014;99:F99–104.
Van Overmeire B, Follens I, Hartmann S, Creten WL, Van Acker KJ. Treatment of patent ductus arteriosus with ibuprofen. Arch Dis Child Fetal Neonatal Ed. 1997;76
Narayanan-Sankar M, Clyman RI. Pharmacology review: pharmacologic closure of patent ductus arteriosus in the neonate. Neoreviews. 2003;4:e215–21.
Dutta S, Singh B, Chessell L, Wilson J, Janes M, McDonald K, et al. Guidelines for feeding very low birthweight infants. Nutrients. 2015;7:423–42.
Walsh MC, Kliegman RM, Fanaroff AA. Necrotizing enterocolitis: a practitioner’s perspective. Pediatr Rev. 1988;9:219–26.
Volpe JJ. Neurology of the Newborn. 5th edn. Philadelphia, PA: Saunders Elsevier; 2008. p. 517–88.
deVries LS, Eken P, Dubowitz LMS. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992;49:1–6.
Jensen EA, Dysart K, Gantz MG, McDonald S, Bamat NA, Keszler M, et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach. Am J Respir Crit Care Med. 2019;200:751–9. https://doi.org/10.1164/rccm.201812-2348OC.
Good WV. Early Treatment for Retinopathy of Prematurity Cooperative Group. Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc. 2004;102:233–48.
Cheung YF, Ho MH, Cheng VY. Mesenteric blood flow response to feeding after systemic-to pulmonary arterial shunt palliation. Ann Thorac Surg. 2003;75:947–51.
McCurnin D, Clyman RI. Effects of a patent ductus arteriosus on postprandial mesenteric perfusion in premature baboons. Pediatrics. 2008;122:e1262–7.
Pereira-da-Silva L, Pita A, Virella D, Serelha M. Oral ibuprofen for patent ductus arteriosus closure in preterm infants: does high osmolality matter? Am J Perinatol. 2008;25:319–20.
Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database Syst Rev. 2018;9:CD003481.
Louis D, Torgalkar R, Shah J, Shah PS, Jain A. Enteral feeding during indomethacin treatment for patent ductus arteriosus: association with gastrointestinal outcomes. J Perinatol. 2016;36:544–8.
We are thankful to the Dean of the institution for allowing us to conduct and publish our data. We also wish to thank Dr Nandkishor Kabra for critical review of the manuscript.
The authors declare no competing interests.
Institutional Ethics Committee, Lokmanya Tilak Municipal medical College & General Hospital, Mumbai (IEC/90/19). The study was performed in accordance with the Declaration of Helsinki.
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Kaur, S., Manerkar, S., Mondkar, J. et al. The dilemma of feeding during the treatment of patent ductus arteriosus with oral ibuprofen in preterm infants ≤30 weeks of gestation—a randomized controlled trial. J Perinatol 43, 203–208 (2023). https://doi.org/10.1038/s41372-022-01597-x