[Therapeutic problems with indomethacin in preterm infants with persistent ductus arteriosus]

Inhibition of PGE production in eight preterm infants with persistent ductus arteriosus and respiratory distress syndrome was associated with marked improvement in the respiratory and circulatory function in all of them. However, in six of them this effect was only transient. In the posttreatment period of five and a half days reopening of the ductus arteriosus was frequently associated with increased PGE production and a drop of indomethacin serum levels. Three of these six infants were transferred for surgical ligation and the other three infants were successfully treated with a second course of indomethacin. The margin between closure of the ductus arteriosus and the deterioration of kidney function in preterm infants treated with a presently recommended indomethacin dosage is too narrow. Before an improved therapeutic procedure has been developed indomethacin treatment for the closure of persistent ductus arteriosus should not generally be recommended in preterm infants.