Related Experiment Videos
Regional cerebral blood flow velocity changes after indomethacin infusion in preterm infants
N C Austin1, P W Pairaudeau, T K Hames
1Department of Neonatal Medicine, Princess Anne Hospital, Southampton.
Insights
Slow infusion of indomethacin effectively reduces cerebral blood flow velocity in preterm infants with patent ductus arteriosus (PDA). This method shows comparable hemodynamic changes to bolus administration, supporting its use with caution.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Cerebrovascular Physiology
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants.
- PDA can lead to significant hemodynamic alterations and complications.
- Indomethacin is a common pharmacologic treatment for PDA.
Purpose of the Study:
- To assess the cerebral hemodynamic effects of slow indomethacin infusion in preterm infants with symptomatic PDA.
- To compare the cerebral blood flow velocity changes with previous studies using bolus indomethacin administration.
Main Methods:
- Cerebral blood flow velocity was measured using Doppler ultrasound.
- Indomethacin was administered via a 30-minute infusion.
- Measurements included time-averaged mean velocity (TAMV), peak systolic velocity (PSV), and end-diastolic velocity (EDV) in cerebral arteries.
Main Results:
- Indomethacin infusion significantly reduced TAMV, PSV, and EDV in both anterior and middle cerebral arteries.
- The maximal reduction in TAMV and PSV occurred 30-40 minutes post-infusion.
- The observed hemodynamic changes were comparable to those seen with bolus indomethacin administration.
Conclusions:
- Slow indomethacin infusion effectively alters cerebral hemodynamics in preterm infants with PDA.
- This administration method produces similar magnitude of changes as bolus administration.
- Indomethacin is effective for PDA but requires cautious use in preterm neonates.
Abstract:
Cerebral blood flow velocity was assessed during infusion of indomethacin over 30 minutes. Eleven preterm infants with symptomatic patent ductus arteriosus were studied on 12 occasions. Indomethacin infusion was associated with a significant reduction in time averaged mean velocity (TAMV), peak systolic velocity (PSV), and end diastolic velocity in both the anterior cerebral artery and middle cerebral artery. The fall in the TAMV and PSV was gradual with maximal change 30-40 minutes after the start of the infusion. It was concluded that administration of indomethacin by slow infusion produces haemodynamic alterations to the cerebral circulation comparable in magnitude with changes described with bolus administration. Indomethacin remains a useful and effective treatment for patent ductus arteriosus in preterm infants, but should continue to be used with caution.