Oral ibuprofen versus intravenous ibuprofen

Prophylactic oral ibuprofen decreased the risk of PDA (RR 0.47, 95% CI 0.30 to 0.74; 4 trials, 202 infants) and increased risk of gastrointestinal bleeding (RR 2.01, 95% CI 1.17, 3.48; NNTH 7, 95% CI 4 to 25). No evidence of a difference was identified for mortality, IVH or chronic lung disease. [5] [LOE I]

For treatment of PDA, one study reported decreased failure to close a PDA after single or three doses of oral ibuprofen compared with placebo (64 infants; RR 0.26, 95% CI 0.11 to 0.62; RD -0.44, 95% CI -0.65 to -0.23; NNTB 2, 95% CI 2 to 4) but other outcomes were not reported. [6] [LOE II]

Comparing oral ibuprofen versus intravenous ibuprofen for treatment of PDA, oral ibuprofen was associated with reduced failure to close the PDA (5 trials, 406 infants RR 0.38, 95% CI 0.26, 0.56), no difference in mortality, need for surgical closure of the ductus, duration of ventilatory support, pulmonary haemorrhage, pulmonary hypertension, chronic lung disease, IVH, periventricular leukomalacia, necrotising enterocolitis (3 trials, 236 infants; RR 0.86, 95% CI 0.35, 2.15), intestinal perforation (2 trials, 134 infants; RR 0.32, 95% CI 0.01, 7.48), gastrointestinal bleed (2 trials, 172 infants; RR 2.89, 95% CI 0.12, 69.24), ROP or neurodevelopment at 18-24 months. Oral ibuprofen was associated with lower creatinine levels after treatment (MD -22.47, 95% CI -32.40, -12.53 µmol/L). [6] [LOE I]