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[Pharmacologic treatment of patent ductus arteriosus in premature infants]
Insights
Oral indomethacin effectively closes large patent ductus arteriosus (DAP) in preterm infants, especially when given early. However, delayed treatment is linked to bronchopulmonary dysplasia and prolonged mechanical ventilation.
Area of Science:
- Neonatology
- Pediatric Cardiology
Context:
- Large patent ductus arteriosus (DAP) is a common complication in preterm infants.
- Many infants with DAP require mechanical ventilation and have hyaline membrane disease.
Purpose:
- To evaluate the efficacy of oral indomethacin for pharmacological closure of large DAP in preterm infants.
- To identify factors influencing treatment response and long-term outcomes.
Summary:
- Sixty-one preterm infants with large DAP were treated with oral indomethacin.
- A 64.5% success rate was observed, with younger infants responding better.
- Long-term survival was 64.5%, with a high incidence of bronchopulmonary dysplasia (BPD) in those receiving later indomethacin treatment.
Impact:
- Early administration of indomethacin may improve outcomes and reduce the incidence of BPD.
- Postnatal age at indomethacin treatment correlates with the duration of mechanical ventilation in survivors.
Abstract:
Sixty-one preterm infants (birthweight, 1.529 +/- 450g; gestational age, 31,9 +/- 2,4 weeks) developed a large DAP. Seventy-eight per cent required mechanical ventilation and 75,5% had hyaline membrane disease. Pharmacological closure of the DAP with oral indomethacin was attempted on 31. A steady improvement was achieved in 64,5%. The postnatal age of responders was lower than that of non-responders. Neonatal survival was over 90% but long-term survival dropped to 64,5% linked to a high incidence of bronchopulmonary dysplasia. The patients with bronchopulmonary dysplasia had received indomethacin later than the others. It was found that postnatal age at the time of indomethacin administration correlated with the days of mechanical ventilation later required by the survivors.