Related Experiment Videos
Effects of highly overdosed indomethacin in a preterm infant with symptomatic patent ductus arteriosus
V Schuster1, H B von Stockhausen, H W Seyberth
1Department of Paediatrics, University of Würzburg, Federal Republic of Germany.
Insights
A preterm infant with severe respiratory distress syndrome experienced a 100-fold overdose of indomethacin, a medication used to treat patent ductus arteriosus. Surprisingly, the infant showed no adverse effects, likely due to good health and fluid intake.
Area of Science:
- Neonatal medicine
- Pharmacology
- Pediatric cardiology
Background:
- Idiopathic respiratory distress syndrome (iRDS) is a common neonatal condition requiring intensive respiratory support.
- Symptomatic patent ductus arteriosus (sPDA) frequently complicates iRDS, necessitating medical or surgical intervention.
- Indomethacin is a standard treatment for sPDA, aiming to induce ductal constriction.
Observation:
- A preterm infant with severe iRDS requiring high ventilatory support developed sPDA.
- An accidental 100-fold overdose of indomethacin was administered during sPDA treatment.
- The infant was in good clinical condition with sufficient fluid intake prior to the overdose.
Findings:
- Despite the massive indomethacin overdose, the infant did not develop expected side effects like renal failure.
- Rapid and persistent closure of the patent ductus arteriosus was achieved.
- The overdose did not appear to negatively impact the infant's overall clinical status.
Implications:
- This case suggests a potentially wider safety margin for indomethacin in select preterm infants than previously assumed.
- Sufficient hydration and a stable clinical condition may mitigate indomethacin-induced renal toxicity.
- Further investigation into the pharmacokinetics and safety of high-dose indomethacin in neonates may be warranted.
Abstract:
We describe a preterm infant with severe idiopathic respiratory distress syndrome (iRDS, hyaline membrane disease) who needed artificial ventilation with high inspiratory pressure, high frequencies, 100% oxygen and developed a symptomatic patent ductus arteriosus (sPDA) in the course of the disease. The infant was given indomethacin to induce constriction of sPDA. Due to an error in drug dilution the patient received a 100-fold overdose of indomethacin. Compared to the normal study protocol side-effects such as renal failure were not observed probably due to sufficient fluid intake and good clinical condition prior to treatment and to the rapid and persistent ductal closure.