***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To test whether early postnatal ( 0 to 3 hours ) intravenous administration of ibuprofen will prevent  patent ductus arteriosus ( PDA ) in preterm neonates . DESIGN Prospect i ve sequential controlled trial with three treatment arms . SETTING Level 3 perinatal-neonatal intensive care nursery . PATIENTS Thirty-four premature newborn infants born from February to August 1993 with a mean birth weight of 913 g ( range , 565 to 1460 g ) and gestational age of 26.9 weeks ( range , 22.4 to 31.0 ) . INTERVENTION Infants were consecutively assigned within 3 hours of age to treatment with either one dose of ibuprofen lysine ( 10 mg/kg intravenously ) followed by 5 mg/kg per dose intravenously at 24 and 48 hours of age ( n = 12 ) , one dose of ibuprofen lysine ( 10 mg/kg intravenously ; n = 11 ) , or saline ( n = 11 ) . OUTCOME VARIABLES Primary outcome variable was the presence of ductus arteriosus by echocardiography and clinical assessment s at 3 , 7 , and 21 days of life . Secondary outcome variables included presence of intraventricular hemorrhage , renal function , ventilatory and oxygen needs , hematologic changes , gastrointestinal function , time to full enteral feeding , duration of hospitalization , and age at discharge . RESULTS The three groups of patients were comparable in birth weight , gestational age , antenatal administration of betamethasone , and other perinatal characteristics .  Ibuprofen treatment significantly reduced plasma levels of prostagl and ins , and the levels remained low for 72 hours in newborns who received three doses of the drug . The incidence of PDA and other variables did not differ between patients who received a single dose of ibuprofen and those given saline . However , compared with the saline-treated newborns , babies who received three doses of ibuprofen had no PDA ( 0/12 vs 7/11 for saline ; P < .02 ) , had lower daily mean airway pressures ( mean + /- SD , 5.2 + /- 1.1 cm H2O vs 8.3 + /- 2.8 cm H2O for saline ; P < .02 ) and better oxygenation index ( 2.6 + /- 0.6 vs 4.7 + /- 1.8 for saline ; P < .02 ) at the end of the first week of life , and required fewer days of ventilation ( 25 + /- 14 days vs 44 + /- 26 days for saline ; P < .03 ) . Babies given three doses of ibuprofen tended to tolerate full oral feedings earlier ( 35 + /- 19 days vs 56 + /- 34 days for saline ; P = .09 ) , had shorter duration of hospitalization ( 71.2 + /- 22.6 days vs 127.3 + /- 74.7 days for saline ; P < .05 ) , and were discharged to home at an earlier postconceptional age ( 37.8 + /- 2.0 weeks vs 44.8 + /- 9.8 weeks for saline ; P < .05 ) . ibuprofen treatment in this phase I trial was not associated with any apparent early neurological , intestinal , renal , hepatic , or hematologic complications . CONCLUSIONS Administration of three doses of ibuprofen within 3 hours after birth in preterm neonates reduced the incidence of PDA without causing notable early adverse drug reactions in this phase I trial . Early closure of the ductus arteriosus was also associated with better respiratory outcome and earlier discharge from the hospital BACKGROUND Indomethacin is the conventional treatment for hemodynamically important patent ductus arteriosus in preterm infants . However , its use is associated with various side effects . In a prospect i ve study , we compared ibuprofen and indomethacin with regard to efficacy and safety for the early treatment of patent ductus arteriosus in preterm infants . METHODS We studied 148 infants ( gestational age , 24 to 32 weeks ) who had the respiratory distress syndrome and an echocardiographically confirmed , hemodynamically important patent ductus arteriosus . The infants were r and omly assigned at five neonatal intensive care centers to receive three intravenous doses of either indomethacin ( 0.2 mg per kilogram of body weight , given at 12-hour intervals ) or ibuprofen ( a first dose of 10 mg per kilogram , followed at 24-hour intervals by two doses of 5 mq per kilogram each ) , starting on the third day of life . The rate of ductal closure , the need for additional treatment , side effects , complications , and the infants ' clinical course were recorded . RESULTS The rate of ductal closure was similar with the two treatments : ductal closure occurred in 49 of 74 infants given indomethacin ( 66 percent ) , and in 52 of 74 given ibuprofen ( 70 percent ) ( relative risk , 0.94 ; 95 percent confidence interval , 0.76 to 1.17 ; P=0.41 ) . The numbers of infants who needed a second pharmacologic treatment or surgical ductal ligation did not differ significantly between the two groups . Oliguria occurred in 5 infants treated with ibuprofen and in 14 treated with indomethacin ( P=0.03 ) . There were no significant differences with respect to other side effects or complications . CONCLUSIONS Ibuprofen therapy on the third day of life is as efficacious as indomethacin for the treatment of patent ductus arteriosus in preterm infants with the respiratory distress syndrome and is significantly less likely to induce oliguria BACKGROUND Patent ductus arteriosus is a common complication of prematurity that frequently requires surgical or medical treatment . The benefit of prophylactic treatment by indometacin , a cyclo-oxygenase inhibitor , remains uncertain compared with curative treatment . This benefit could be improved with ibuprofen , another cyclo-oxygenase inhibitor with fewer adverse effects than indometacin on renal , mesenteric , and cerebral perfusion . We aim ed to compare prophylactic and curative ibuprofen in the treatment of this abnormality in very premature infants . METHODS We did a r and omised controlled trial in infants younger than 28 weeks of gestation , who were r and omly assigned to receive either three doses of  ibuprofen or placebo  within 6 h of birth . After day 3 , symptomatic patent ductus arteriosus was treated first by open curative ibuprofen , then back-up indometacin , surgery , or both . The primary endpoint was need for surgical ligation . Analysis was per protocol . FINDINGS The study was stopped prematurely after 135 enrollments because of three cases of severe pulmonary hypertension in the prophylactic group . 65 infants received prophylactic ibuprofen  , and 66 received  placebo .  Prophylaxis reduced the need for surgical ligation from six ( 9 % ) to zero ( p=0.03 ) , and decreased the rate of severe intraventricular haemorrhage from 15 ( 23 % ) to seven ( 11 % ) ( p=0.10 ) . However , survival was not improved ( 47 [ 71 % ] placebo vs 47 [ 72 % ] treatment , p=1.00 ) , because of high frequency of adverse respiratory , renal , and digestive events . INTERPRETATION In premature infants , prophylactic ibuprofen reduces the need for surgical ligation of patent ductus arteriosus , but does not reduce mortality or morbidity . Therefore , it should not be preferred to early curative ibuprofen A prospect i ve r and omized controlled trial was performed to compare the effects of ibuprofen with indomethacin on cerebral hemodynamics measured using near infrared spectroscopy in preterm infants during treatment for patent ductus arteriosus . Infants were r and omly assigned to three intravenous doses of either indomethacin ( 0.20–0.25 mg/kg , 12 hourly ) or ibuprofen ( 5–10 mg/kg , 24 hourly ) and also received a dose of saline . The primary end points of the study were the effects of the first dose on cerebral blood flow ( CBF ) and cerebral blood volume . Fifteen infants received indomethacin and 18 received ibuprofen .  The group mean ( SD ) values for CBF ( mL·100 g−1·min−1 ) before and after the first dose of indomethacin were 13.6 ( 4.1 ) and 8.3 ( 3.1 ) , respectively , the change being significant ( p < 0.001 ) . In contrast , no significant changes in CBF were observed with the first dose of ibuprofen , the respective before and after values being 13.3 ( 3.2 ) and 14.9 ( 4.7 ) mL·100 g−1·min−1 . The median ( interquartile range ) value for change in cerebral blood volume ( mL/100 g ) after the first dose in the indomethacin group was −0.4 ( −0.3 to −0.6 ) and in the ibuprofen group was 0.0 ( 0.1 to −0.1 ) , the difference between the two groups being significant ( p < 0.001 ) . Cerebral oxygen delivery changed significantly after the first dose in the indomethacin group but not in the ibuprofen group . Significant reductions in CBF , cerebral blood volume , and cerebral oxygen delivery also occurred after the 24-h dose of indomethacin , but there were no significant changes after the 48-h dose of saline in the indomethacin group or after the 24- and 48-h doses of ibuprofen . The patent ductus arteriosus closure rates after indomethacin and ibuprofen were 93 and 78 % , respectively . We conclude that ibuprofen , unlike indomethacin , has no adverse effects on cerebral hemodynamics and appears to mediate patent ductus arteriosus closure We investigated the effects of clinical ly comparable doses of ibuprofen and indomethacin on renal , gastrointestinal and cerebral perfusion in newborn piglets , and hypothesized that ibuprofen would have less effect on regional circulation . Animals were r and omly assigned to receive ibuprofen ( 20 mg/kg , n = 8) , indomethacin ( 0.3 mg/kg , n = 7 ) or vehicle ( n = 6 ) . Fluorescent microspheres were injected prior to and at 20 , 40 , 60 , 90 and 120 min after drug administration . Regional blood flow was measured and vascular resistances were calculated . Cardiovascular and respiratory variables were not significantly affected by either study drug or vehicle . Ibuprofen increased renal cortical and medullary resistance by 44 and 52 % ( p < 0.05 ) . However , ibuprofen had no significant effects on gastrointestinal or cerebral resistance . Indomethacin raised renal cortical and medullary resistance by 66 and 71 % at 60 min postinjection , respectively ( p < 0.05 ) . Indomethacin increased duodenojejunal , ileal and colon resistance by 97 , 102 and 75 % at 60 min , respectively ( p < 0.05 ) . Indomethacin increased cerebral cortical and cerebellar resistance by 92 and 86 % at 90 min ( p < 0.05 ) . While indomethacin and , to a lesser extent , ibuprofen both increase renal vascular resistance , indomethacin vasoconstricts the gastrointestinal and cerebral circulations which are unaffected by ibuprofen Aim The aim of this study was to explore the effects of early oral ibuprofen administration on the incidence of  hemodynamically significant patent ductus arteriosus ( hsPDA )  and define the association between serum ibuprofen levels and ductal closure . Method Preterm infants with a gestational age of < 28 weeks and /or birth weight of < 1,000 g were r and omized either to the intervention ( ibuprofen prophylaxis ) or control group . The intervention group received oral ibuprofen 10 mg/kg within 12–24 h after birth followed by 5 mg/kg at 24 and 48 h. Serum ibuprofen levels after the treatment were analyzed in the intervention group , and the incidence of hsPDA and complication rates were compared between two groups . Results Nineteen infants who received one course ( three doses ) of prophylactic ibuprofen in the intervention group and 17 infants in the control group who underwent an echocardiographic examination on the fourth day of life were analyzed . hsPDA was observed in five ( 26 % ) infants in the intervention group and ten ( 58 % ) infants in the control group ( p = 0.09 ) . In the intervention group two infants experienced gastrointestinal bleeding two infants had spontaneous intestinal perforation , and two infants developed acute kidney failure . Mean serum ibuprofen level 
    Output:
    
Ibuprofen negatively affects renal function .
Prophylactic use of ibuprofen decreased the incidence of PDA , decreased the need for rescue treatment with cyclo-oxygenase inhibitors and decreased the need for surgical closure .