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Prevention of symptomatic patent ductus arteriosus with a single dose of indomethacin
E Krueger1, M Mellander, D Bratton
1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Prophylactic indomethacin significantly reduced symptomatic patent ductus arteriosus (PDA) in preterm infants. This treatment showed no adverse effects on other common infant complications.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is a common complication in preterm infants, particularly those with hyaline membrane disease.
- Symptomatic PDA can lead to significant morbidity and mortality in neonates.
- Effective preventative strategies for PDA are crucial in neonatal intensive care.
Purpose of the Study:
- To evaluate the efficacy of prophylactic indomethacin in preventing symptomatic patent ductus arteriosus (PDA) in preterm infants.
- To assess the impact of prophylactic indomethacin on other neonatal complications.
Main Methods:
- A randomized clinical trial was conducted on 32 preterm infants (750-1500 g) with hyaline membrane disease.
- 15 infants received a single intravenous dose of indomethacin (0.2 mg/kg) 24 hours after birth.
- 17 infants served as a control group, receiving indomethacin only for symptomatic PDA.
Main Results:
- Only one of 14 survivors receiving prophylactic indomethacin developed symptomatic PDA, versus nine of 16 survivors in the control group (P = 0.007).
- No significant differences were observed in the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, or necrotizing enterocolitis between the groups.
- There were no differences in the duration of endotracheal intubation, oxygen support, time to full feedings, weight gain, or hospital stay.
Conclusions:
- Prophylactic indomethacin is effective in preventing symptomatic PDA in preterm infants with hyaline membrane disease.
- The study suggests no increased risk of pulmonary sequelae or other common complications with prophylactic indomethacin.
- Larger sample sizes may be needed to definitively assess the impact on less frequent complications.
Abstract:
To determine the efficacy of indomethacin to prevent the occurrence of symptomatic patent ductus arteriosus (PDA), a randomized clinical trial was conducted involving 32 preterm infants weighing 750 to 1500 g at birth who had hyaline membrane disease. By random assignment, 15 infants were given a single dose of indomethacin, 0.2 mg/kg intravenously, 24 hours after birth. Seventeen infants composed a control group for which indomethacin was reserved as treatment for symptomatic PDA. Birth weight, gestational age, male/female ratio, black/white ratio, and severity of disease were similar for both groups. Only one of the 14 survivors who received prophylactic indomethacin had symptomatic PDA, compared with nine of the 16 survivors in the control group (P = 0.007). There was no difference between the groups in development of bronchopulmonary dysplasia, duration of time endotracheal intubation, was required, duration in oxygen, duration to reach full feedings and regain birth weight, and duration of hospital stay. There was no difference between the two groups in incidence of intraventricular hemorrhage, and none developed necrotizing enterocolitis. These results indicate that the use of prophylactic indomethacin is beneficial in prevention of symptomatic PDA; the lack of differences in pulmonary sequelae or other complications may have been related to a population sample size not large enough to impart sufficient statistical power.