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Indomethacin therapy in infants with advanced postnatal age and patent ductus arteriosus
Insights
Indomethacin is ineffective for closing the ductus arteriosus in premature infants older than 8 weeks. This study found no ductal closure despite achieving therapeutic indomethacin levels.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Pediatric Cardiology
Background:
- The patent ductus arteriosus (PDA) is a common condition in premature infants.
- Indomethacin is a commonly used medication to promote PDA closure.
- Efficacy of indomethacin may decrease with advanced postnatal age.
Purpose of the Study:
- To evaluate the efficacy of intravenous indomethacin for PDA closure in premature infants with advanced postnatal age (≥8 weeks).
Main Methods:
- A trial involving 11 premature infants (mean postnatal age 65.3 days) receiving intravenous indomethacin.
- Dosage: 0.3 mg/kg every 8 hours for 3 doses (total 0.9 mg/kg).
- Plasma levels and area under the curve were monitored.
Main Results:
- None of the 11 infants showed ductus arteriosus closure despite achieving therapeutic plasma indomethacin levels (280-870 ng/ml).
- Transient decreases in urine output, creatinine clearance, and fractional excretion of sodium were observed.
- No significant adverse effects were reported beyond transient renal function changes.
Conclusions:
- Intravenous indomethacin is ineffective for achieving ductus arteriosus closure in premature infants with postnatal age of 8 weeks or more.
- Clinical management strategies for PDA in older premature infants may need to consider alternative treatments.
Abstract:
A trial of intravenous indomethacin therapy was performed on 11 premature infants whose postnatal age was 8 weeks or more (mean 65.3 days). In an attempt to maintain the desired plasma level, indomethacin was given at a dosage of 0.3 mg/kg, at 8-hour intervals (total dose 0.9 mg/kg) for a total of 3 doses. In spite of desirable plasma indomethacin levels (which ranged from 280-870 ng/ml) and area under the curve (24.1 micrograms/hr/ml), calculated from time 0 to 24 hrs after the initial dose, none of the infants responded to indomethacin with ductus closure. There were a transient significant decrease in urine output, creatinine clearance, and fractional excretion of sodium. The present study confirms the clinical impression that Indomethacin is ineffective for the closure of ductus arteriosus in infants with advanced postnatal age.