Early ibuprofen exposure conveys elevated risk of BPD in extremely preterm babies

The risk of developing bronchopulmonary dysplasia (BPD) appears to be twofold higher in neonates exposed to ibuprofen during the first days of life, a study has found.

Researchers examined the medical records of 203 extremely premature infants. There were 87 infants (42.8 percent) who received at least one course of ibuprofen for the treatment of patent ductus arteriosus (PDA), with treatment resulting in a successful closure rate of 35.6 percent (n=31) within 48 hours after treatment completion. The median age at the first dose was 6.5 days, with median feeding volume of 1 ml per feeding.

Sixty-two infants (30.5 percent) developed BPD, and the proportion was significantly higher in the group of those with vs without early exposure to ibuprofen (42.5 percent vs 21.6 percent; p=0.001).

In multivariable regression models, the risk of BPD showed a positive association with ibuprofen exposure (odds ratio [OR], 2.296, 95 percent confidence interval [CI], 1.166–4.522; p=0.016). Moreover, there was a trend toward increased BPD risk in those with successful PDA closure after ibuprofen treatment than in nontreated infants (32.3 percent vs 20.2 percent; p=0.162).

While unclear, the mechanisms underlying the association between early ibuprofen exposure and heightened BPD risk may involve the antiangiogenetic effect of the drug, according to the researchers, adding that such is possible among extremely premature infants who are more vulnerable to blocked angiogenesis.

However, the researchers noted that multiple courses of ibuprofen treatment did not lead to a significantly increased risk of BPD in the current study, which may be attributed to the small sample size. Therefore, more studies with larger populations are warranted to further examine the possible negative effects of ibuprofen exposure on the developing premature lung.