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Effect of a modified fluid therapy on renal function during indomethacin therapy for persistent ductus arteriosus
J U Leititis1, R Burghard, N Gordjani
1Department of Paediatrics, Philipps-University, Marburg, FRG.
Insights
Preterm infants receiving a specific fluid rehydration before indomethacin treatment showed preserved renal function. This approach also aided in closing the persistent ductus arteriosus, minimizing adverse effects in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Pharmacology
Background:
- Persistent ductus arteriosus (PDA) is common in premature infants.
- Indomethacin is frequently used to treat PDA but can cause adverse renal effects.
- Neonatal renal function is sensitive to hemodynamic changes and medications.
Purpose of the Study:
- To evaluate the effect of a pre-administration fluid regimen on indomethacin's renal toxicity in premature infants with PDA.
- To assess renal function and ductal closure rates with the modified fluid protocol.
Main Methods:
- Premature infants with PDA received a 6-hour pre-treatment rehydration (7 ml/kg/h).
- Indomethacin was administered post-rehydration, with a 36-hour observation period.
- Renal function markers (serum creatinine, electrolytes, urinary flow, creatinine clearance, fractional sodium excretion) were monitored.
Main Results:
- The fluid regimen prevented adverse renal effects of indomethacin.
- No significant changes in serum creatinine, sodium, or potassium were observed.
- A reduction in fractional sodium excretion was the primary significant finding, suggesting suppressed vasoconstriction.
- Ductal closure was achieved in 7 out of 10 treatment courses without cardiovascular side effects.
Conclusions:
- A pre-administration fluid load effectively mitigates indomethacin-induced renal dysfunction in preterm neonates with PDA.
- This modified fluid regimen supports ductal closure while preserving renal function and avoiding cardiovascular complications.
- The findings suggest a potential role for fluid management in optimizing indomethacin therapy for PDA.
Abstract:
A rehydration with 7 ml/kg/h for six hours prior to indomethacin administration prevented the adverse effects of this drug on renal function in prematures with persistent ductus arteriosus. During the 36 hour observation period after indomethacin administration, no significant changes in serum creatinine, sodium, and potassium concentrations, or urinary flow, creatinine clearance, or filtered sodium could be detected. The only significant finding was a reduction in fractional sodium excretion. One can assume that this beneficial effect of the fluid load is due to a suppression of some parts of the vasoconstrictor mechanisms, which are responsible for the deterioration of renal function in newborns during indomethacin therapy. Using this modified fluid regimen, no cardiovascular side effects were noticed, a closure of the duct was achieved in 7 of 10 treatment courses.