Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus

Ronald Clyman, Andrea Wickremasinghe, Nami Jhaveri, Denise C. Hassinger, Joshua T. Attridge, Ulana Sanocka, Richard Polin, Maria Gillam-Krakauer, Jeff Reese, Mark Mammel, Robert Couser, Neil Mulrooney, Toby D. Yanowitz, Matthew Derrick, Priya Jegatheesan, Michele Walsh, Alan Fujii, Nicolas Porta, William A. Carey, Jonathan R. Swanson

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Objective: To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive "trophic" (15 mL/kg/d) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus. Study design: Infants were eligible for the study if they were 231/7-306/7 weeks' gestation, weighed 401-1250 g at birth, received maximum enteral volumes ≤60 mL/kg/d, and were about to be treated with indomethacin or ibuprofen. A standardized "feeding advance regimen" and guidelines for managing feeding intolerance were followed at each site (N = 13). Results: Infants (N = 177, 26.3 ± 1.9 weeks' mean ± SD gestation) were randomized at 6.5 ± 3.9 days to receive "trophic" feeds ("feeding" group, n = 81: indomethacin 80%, ibuprofen 20%) or no feeds ("fasting [nil per os]" group, n = 96: indomethacin 75%, ibuprofen 25%) during the drug administration period. Maximum daily enteral volumes before study entry were 14 ± 15 mL/kg/d. After drug treatment, infants randomized to the "feeding" arm required fewer days to reach the study's feeding volume end point (120 mL/kg/d). Although the enteral feeding end point was reached at an earlier postnatal age, the age at which central venous lines were removed did not differ between the 2 groups. There were no differences between the 2 groups in the incidence of infection, necrotizing enterocolitis, spontaneous intestinal perforation, or other neonatal morbidities. Conclusion: Infants required less time to reach the feeding volume end point if they were given "trophic" enteral feedings when they received indomethacin or ibuprofen treatments.

Original languageEnglish (US)
Pages (from-to)406-411.e4
JournalJournal of Pediatrics
Issue number2
StatePublished - Aug 2013


  • BPD
  • Bronchopulmonary dysplasia
  • NEC
  • Necrotizing enterocolitis
  • Nil per os
  • PDA
  • Patent ductus arteriosus
  • npo

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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