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Localized intestinal perforation after intravenous indomethacin in a premature infant
Helvetica Paediatrica Acta
|December 1, 1986
Insights
Intravenous indomethacin, used for patent ductus arteriosus (PDA) closure in premature infants, may cause serious gastrointestinal complications like ileal perforation. This suggests non-local mechanisms may contribute to these adverse events in neonates.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is common in premature infants.
- Indomethacin is frequently used to pharmacologically close PDA.
- Gastrointestinal complications are known risks of indomethacin therapy.
Observation:
- A 27-week premature infant developed terminal ileum perforation six days after intravenous indomethacin.
- This occurred despite the drug being administered intravenously, not enterally or rectally.
- Previous reports linked indomethacin-induced perforations to local administration routes.
Findings:
- Intravenous indomethacin administration was associated with localized ileal perforation in a premature infant.
- The findings challenge the assumption that gastrointestinal lesions are solely due to local drug effects.
- Systemic effects of indomethacin may play a role in neonatal gastrointestinal injury.
Implications:
- Clinicians should consider the risk of gastrointestinal perforation with intravenous indomethacin in neonates.
- Further research is needed to elucidate the systemic mechanisms of indomethacin-induced intestinal injury.
- This case highlights the importance of monitoring for surgical complications in premature infants receiving indomethacin.
Abstract:
A female premature infant born after 27-week gestation developed a localized perforation of the terminal ileum six days after the administration of intravenous indomethacin for PDA closure. This complication has been reported after enteral and rectal administration of the drug. However, our clinical finding supports that these lesions in premature infants are not only related to the local effects of enteral indomethacin.