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Late closure of the ductus arteriosus using indomethacin in the preterm infant
M J Kresch1, F R Moya, R J Ascuitto
1Department of Pediatrics Yale University School of Medicine, New Haven, CT 06510.
Insights
Indomethacin may effectively close a patent ductus arteriosus (PDA) in preterm infants older than 20 days. Postconceptual age, not postnatal age, appears key for successful PDA treatment.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants.
- Indomethacin is a standard treatment, but efficacy decreases after 14 days of postnatal age.
- Hemodynamically significant PDAs pose risks like necrotizing enterocolitis and intraventricular hemorrhage.
Observation:
- Two cases of preterm infants over 20 days old with hemodynamically significant PDAs successfully treated with indomethacin are presented.
- These infants were under 34 weeks postconceptual age.
- Response to indomethacin may correlate with postconceptual age rather than postnatal age.
Findings:
- Intravenous indomethacin achieved closure of hemodynamically significant PDAs in preterm infants beyond the typical 14-day efficacy window.
- Postconceptual age appears to be a more critical factor than postnatal age in determining indomethacin responsiveness for PDA closure.
- Successful treatment in these cases suggests a potential role for indomethacin in select older preterm infants.
Implications:
- Consideration of intravenous indomethacin therapy before surgical ligation for preterm infants under 34 weeks postconceptual age with hemodynamically significant PDAs.
- This approach may reduce the need for surgical intervention and associated risks.
- Further research is warranted to confirm the role of postconceptual age in guiding PDA treatment strategies.
Abstract:
Several studies have shown a lack of effect of indomethacin therapy for the closure of a patent ductus arteriosus (PDA) in premature infants over 14 days of postnatal age. In this report we describe two cases in which a hemodynamically significant PDA was closed with indomethacin in preterm infants over 20 days of age. The response to indomethacin may be more related to postconceptual age than to actual postnatal age. We suggest that intravenous indomethacin therapy should be attempted before surgical ligation is performed in those premature infants under 34 weeks postconceptual age who have a hemodynamically significant patent ductus arteriosus.