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Decreased early diastolic function after indomethacin administration in premature infants
R S Appleton1, T P Graham, R B Cotton
1Department of Pediatrics, Vanderbilt Medical University, Nashville, Tennessee.
Insights
Indomethacin negatively impacts early diastolic function in premature infants, affecting both those treated for patent ductus arteriosus and those receiving prophylactic treatment. Systolic function remained unaffected by this medication.
Area of Science:
- Neonatal Cardiology
- Pharmacology
- Pediatric Echocardiography
Background:
- Patent ductus arteriosus (PDA) is common in premature infants.
- Indomethacin is frequently used to treat or prevent PDA.
- The impact of indomethacin on cardiac function in neonates requires further elucidation.
Purpose of the Study:
- To evaluate the effect of indomethacin on systolic and diastolic cardiac function in premature infants.
- To compare the effects in infants treated for clinically significant PDA versus those receiving prophylactic indomethacin.
Main Methods:
- M-mode echocardiography was used to assess cardiac function in 15 premature infants.
- Diastolic function was evaluated using the maximum velocity of lengthening of the left ventricular (LV) cavity dimension.
- Systolic function indices were also monitored.
Main Results:
- Indomethacin significantly decreased early diastolic function in both treatment groups (P < 0.01).
- The maximum velocity of LV lengthening fell post-indomethacin administration.
- Normalized diastolic function indices also showed a decrease after indomethacin.
- No significant changes were observed in systolic function indices.
Conclusions:
- Indomethacin administration impairs early diastolic cardiac function in premature infants.
- This effect is observed regardless of whether indomethacin is used for treatment or prophylaxis of PDA.
- Further research may be warranted to explore the long-term implications of these findings.
Abstract:
The effect of indomethacin on systolic and diastolic cardiac function was assessed in 15 premature infants. Seven infants (group 1) received indomethacin to treat a clinically significant patent ductus arteriosus (PDA), and eight infants (group 2) received indomethacin prophylactically at 24 hours of age because of their high risk for PDA. Diastolic cardiac function was assessed using instantaneous rates of change of left ventricular (LV) cavity dimension, derived from M-mode echocardiography. The maximum velocity of lengthening of the LV cavity dimension, an index of early diastolic function, fell from 63 +/- 19 mm/sec before indomethacin to 48 +/- 16 mm/sec 1 hour after indomethacin in group 1 (P less than 0.01), with the ductus still patent and the LV chamber still dilated, and also decreased in group 2, from 52 +/- 7 mm/sec to 38 +/- 6 mm/sec (P less than 0.01). This index, when normalized for loading conditions, was decreased 1 hour after indomethacin at 12 +/- 2 sec-1 and 12 +/- 1 sec-1 for groups 1 and 2, respectively, compared with values before indomethacin of 15 +/- 3 sec-1 and 15 +/- 2 sec-1. There was no effect of indomethacin on the indices of systolic function. We conclude that indomethacin decreases early diastolic function in premature infants.