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Short versus prolonged indomethacin therapy for patent ductus arteriosus in preterm infants
O Tammela1, R Ojala, T Iivainen
1Departments of Paediatrics and Clinical Physiology, Tampere University Hospital, Tampere, Finland.
Insights
A short course of indomethacin is as effective as a prolonged low-dose regimen for treating patent ductus arteriosus (PDA) in preterm infants, with fewer side effects and less need for surgery.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants.
- Indomethacin is a standard treatment for PDA.
- Optimal dosing and duration for indomethacin are debated.
Purpose of the Study:
- To compare the efficacy and safety of a prolonged low-dose indomethacin regimen versus a short standard-dose regimen for PDA in preterm infants.
Main Methods:
- Randomized controlled trial involving 61 preterm infants (24-32 weeks gestational age) with confirmed PDA.
- Infants received either a short (24-hour) or long (7-day) course of indomethacin.
- Echocardiography and side effect monitoring were performed throughout the study.
Main Results:
- The short-course indomethacin group showed a higher rate of initial PDA closure (94% vs. 67%).
- Sustained closure rates were similar between groups (74% vs. 60%).
- The short-course group experienced fewer surgical ligations, less oxygen use, and reduced necrotizing enterocolitis and urea retention.
Conclusions:
- A prolonged low-dose indomethacin regimen provides no significant advantage over a standard short-course regimen for managing hemodynamically significant PDA in preterm infants.
- Short-course indomethacin appears to be a safer and more effective option, reducing the need for surgical intervention and associated morbidities.
Objective:
To evaluate whether a prolonged low-dose course of indomethacin would produce an improved closure rate and have fewer side effects compared with a short standard dosage schedule in the management of patent ductus arteriosus (PDA) in preterm infants.
Study Design:
Sixty-one infants of gestational ages 24 to 32 weeks with a PDA confirmed with echocardiography were randomized to receive 0.2 to 0.1 to 0.1 mg/kg indomethacin in 24 hours (short course, n = 31) or 0.1 mg/kg every 24 hours 7 times (long course, n = 30). Echocardiography was done 3, 9, and 14 days after the treatment was started, and side effects were monitored.
Results:
Primary PDA closure occurred more often in the short course group (94% vs 67%, P =.011), but the sustained closure rates were not different (74% vs 60%). Surgical PDA ligations were less frequent in the short course group than in the long course group. The short course group had a shorter duration of oxygen supplementation, less frequent symptoms of necrotizing enterocolitis, and a lower rate of urea retention. Mortality and other neonatal morbidity rates were similar.
Conclusion:
A prolonged low-dosage indomethacin regimen offers no advantage compared with a standard-dosage short course in the management of a hemodynamically significant PDA in preterm infants.