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Published on: January 7, 2018
Failure of indomethacin to close persistent ductus arteriosus in infants weighing under 1000 grams
Insights
Extremely preterm infants with persistent ductus arteriosus showed only temporary responses to indomethacin. Surgical ligation may be a safer alternative due to indomethacin
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Persistent ductus arteriosus (PDA) is common in preterm infants.
- Conventional medical management often fails in extremely preterm neonates.
- Pharmacological closure with indomethacin is a common treatment strategy.
Purpose of the Study:
- To evaluate the efficacy and safety of indomethacin for PDA in extremely preterm infants (<1000g).
- To compare indomethacin treatment with surgical ligation in this high-risk population.
Main Methods:
- Retrospective review of six preterm infants (<1000g) with PDA.
- Administration of indomethacin to induce ductal closure.
- Observation of treatment response, side effects, and need for surgical intervention.
Main Results:
- All infants showed a transient response to indomethacin.
- No infant achieved permanent closure with indomethacin, despite multiple doses.
- One infant experienced severe adverse events including anuria, uraemia, and gastrointestinal bleeding.
- Three infants underwent successful surgical ligation after failed indomethacin therapy.
Conclusions:
- Extremely preterm infants may be poor responders to indomethacin for PDA closure.
- Indomethacin carries potentially life-threatening side effects in this population.
- Surgical ligation should be strongly considered as an alternative to indomethacin in extremely preterm infants with PDA.
Abstract:
Six preterm infants with a persistent ductus arteriosus, who failed to improve with conventional medical management, received indomethacin in an attempt to close the duct pharmacologically. All infants weighed less than 1000 g when the drug was administered. All showed a transient response to indomethacin; however, no infant demonstrated a permanent response, even though 5 of the 6 received multiple doses. One of the patients developed a severe episode of anuria, uraemia, and gastrointestinal bleeding. Of the 6 infants, 3 underwent subsequent successful surgical ligation of the ductus. It is suggested that the extremely preterm infant may be a 'poor responder' to indomethacin. Since the side effects of indomethacin may be life-threatening, it may be wise to consider surgical ligation in lieu of indomethacin administration in these infants.
