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Cerebral blood flow velocity changes in preterm infants after a single dose of indomethacin: duration of its effect
F Van Bel1, M Van de Bor, T Stijnen
1Department of Pediatrics, University Hospital, Leiden, The Netherlands.
Insights
Indomethacin reduces cerebral blood flow velocity in preterm infants. This effect lasts for at least 2 hours, potentially impacting vulnerable newborns with patent ductus arteriosus.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants.
- Indomethacin is used to treat PDA but can affect cerebral circulation.
- The duration of indomethacin's impact on cerebral blood flow is not well-defined.
Purpose of the Study:
- To evaluate the duration of indomethacin's effect on cerebral blood flow velocity in preterm infants with PDA.
Main Methods:
- 24 preterm infants with symptomatic PDA received a single IV dose of indomethacin (0.1 mg/kg).
- Cerebral blood flow velocity (peak systolic, mean, end-diastolic) in anterior cerebral arteries was measured using Doppler ultrasound before and up to 12 hours post-dose.
- Serial Doppler investigations tracked changes in flow velocities.
Main Results:
- Indomethacin caused an immediate decrease in all measured cerebral blood flow velocities.
- The maximal reduction occurred between 2 and 40 minutes post-administration.
- Flow velocities began a sustained recovery, with temporal mean flow velocity returning to baseline by 3 hours.
Conclusions:
- Indomethacin significantly impacts preterm infant cerebral circulation for at least 2 hours.
- This cerebral circulatory effect may have implications for preterm infants with hemodynamic instability and compromised pulmonary function.
Abstract:
Indomethacin decreases cerebral blood flow velocity and blood flow in the preterm infant. The duration of this negative effect has not been established. Cerebral blood flow velocity was evaluated in 24 preterm infants with symptomatic patent ductus arteriosus before and during the first 12 hours after a single intravenous dose of indomethacin, 0.1 mg/kg. Cerebral blood flow velocity was estimated by serial Doppler investigations of the anterior cerebral arteries. Indomethacin administration led to an instantaneous decrease of peak systolic flow velocity, temporal mean flow velocity, and end-diastolic flow velocity of the anterior cerebral arteries in all infants, which was maximal between 2 and 40 minutes after indomethacin administration and was followed by a more sustained recovery of all velocities to baseline values. Temporal mean flow velocity was not different from pre-indomethacin values at 3 hours after the administration. It is concluded that indomethacin can impact the cerebral circulation of the preterm infant for at least 2 hours. This may have consequences in preterm infants with unstable hemodynamics and pulmonary function.