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[Response to the treatment with indomethacin in persistent ductus arteriosus]
G Flores-Nava1, H Joachín-Roy, M L González-Aguado
1Unidad de Cuidados Intensivos Neonatales, Hospital de Gineco-Obstetricia Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, D.F.
Insights
Indomethacin effectively closes the persistent arterial duct in newborns, improving survival rates. This study highlights its benefits for critically ill infants in the Intensive Care Unit.
Area of Science:
- Neonatal Cardiology
- Pediatric Critical Care Medicine
- Pharmacology
Context:
- Persistent arterial duct (PDA) is a common condition in newborns requiring intensive care.
- Diagnosis of PDA often occurs after the fifth day of life, with characteristic clinical findings.
- Radiological and echocardiographic assessments are crucial for diagnosing PDA and its severity.
Purpose:
- To review clinical findings, diagnostic methods, and treatment outcomes for persistent arterial duct in neonates.
- To evaluate the efficacy of indomethacin in closing the arterial duct.
- To compare outcomes between neonates treated with indomethacin and those who were not.
Summary:
- A review of 46 neonates with PDA revealed common clinical signs like murmurs and hyperdynamic precordium.
- Echocardiography showed an average left atrium/aorta ratio of 1.4.
- Indomethacin successfully closed the duct in 84% of treated infants, with improved survival compared to untreated infants.
Impact:
- Indomethacin demonstrates significant efficacy in closing the persistent arterial duct in neonates.
- Treatment with indomethacin is associated with improved survival rates in critically ill newborns with PDA.
- These findings support the use of indomethacin as a primary treatment for selected cases of persistent arterial duct.
Abstract:
The clinical charts of 46 newborn babies with persistent arterial duct, hospitalized in the Intensive Care Unit were reviewed. The diagnosis was made, on the average, after the fifth day of life, finding a precordial murmur in 75%, hyperdynamic precordium in 48%, and outstanding pulses in 22%. Radiologically, cardiomegaly was seen in 50% of the cases, an increase in the flow of the pulmonary artery in 41%, and no abnormalities 35%. Using echocardiography, the left atrium/aorta relation was found to be 1.4 on the average. Of the 25 patients who received indomethacin to close the conducts arteriosum, 21 (84%) responded favorably. The mortality rate was 43%. A comparative study was done between those children who were given the indomethacin and those who weren't, finding a significant difference in favor of those who did receive the medication when seeing the closure of the conduct and their survival rate.