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Relationship between circulating platelet counts and ductus arteriosus patency after indomethacin treatment
Nidhi A Shah1, Nancy K Hills, Nahid Waleh
1Department of Pediatrics, University of California San Francisco CA, USA.
Insights
Low platelet counts do not impact the closure of patent ductus arteriosus (PDA) in preterm infants treated with indomethacin. This finding contrasts with mouse studies, suggesting species-specific responses in PDA treatment.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Hematology
Background:
- Patent ductus arteriosus (PDA) is a common complication in preterm infants.
- Indomethacin is a frequently used medication to close PDA.
- The role of platelet counts in PDA treatment outcomes is not fully understood.
Purpose of the Study:
- To investigate the association between platelet counts and the incidence of PDA closure following indomethacin treatment in preterm infants.
- To determine if low platelet counts influence the effectiveness of indomethacin in constricting the ductus arteriosus.
Main Methods:
- A cohort of 497 preterm infants receiving indomethacin within 15 hours of birth was analyzed.
- Multivariable logistic regression modeling was employed to assess the relationship between platelet counts and PDA outcomes.
Main Results:
- Platelet counts were not significantly related to the permanent closure of PDA after indomethacin treatment.
- While a relationship existed with initial constriction, it was driven by high platelet counts.
- PDA incidence was similar across various platelet count ranges, except for consistently high counts (>230 ×10⁹/L) which showed decreased incidence.
Conclusions:
- Low circulating platelet counts do not appear to affect permanent ductus closure or reopening in human preterm infants treated with indomethacin.
- These findings in humans differ from observations in mouse models.
- Platelet count thresholds may not be a critical factor for indomethacin efficacy in PDA management.
Objective:
To determine whether low platelet counts are related to the incidence of patent ductus arteriosus (PDA) after indomethacin treatment in preterm human infants.
Study Design:
Multivariable logistic regression modeling was used for a cohort of 497 infants, who received indomethacin (within 15 hours of birth).
Results:
Platelet counts were not related to the incidence of permanent closure after indomethacin constriction. There was a relationship between platelet counts and the initial degree of constriction; however, this relationship appeared to be primarily influenced by the high end of the platelet distribution curve. PDA incidence was similar in infants with platelet counts < 50 × 10⁹/L and those with platelet counts above this range. Only when platelet counts were consistently >230 ×10⁹/L was there a decrease in PDA incidence.
Conclusion:
In contrast to the evidence in mice, low circulating platelet counts do not affect permanent ductus closure (or ductus reopening) in human preterm infants.
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