[Closure of Botallo's ductus arteriosus with indomethacin. Considerations on 4 cases]

Persistence of Patent Ductus Arteriosus (PDA) frequently occurs in preterm infants. In a remarkable number of cases, PDA may undergo spontaneous closure. In other cases, especially in patients with respiratory problems, a ductal left-to-right shunt may compromise the cardiac-respiratory function. Until a few years ago, surgery was the only possible therapy. Recently, pharmacological closure of the duct by means of Indomethacin, a powerful inhibitor of prostaglandin synthesis, was successfully carried out. The medical treatment, however, appears to be less effective if it is carried out on patients older than 2 weeks. It has also been reported that in patient with a very low birthweight and with lack of muscular tissue in the duct wall, closure of the duct may be transient. It is the purpose of this communication to report observations made on 4 preterm infants of 24-33 weeks gestational age, and with a weight range of 660 to 2.280 g. They received Indomethacin via naso-gastric tube, in a single dose of 0,3 mg/Kg, within 8 days of age. Successful closure of the PDA was obtained in all cases. The pharmacological treatment resulted also in reductions in ventilatory support requirements, reduced respiratory component of acidosis, reduced pCO2, increased pO2. A second administrations of Indo was necessary only in one case, and it was followed by permanent closure of the duct. Collateral effects, such as reduced diuresis and reduced number of platelets, were transient. Indo therapy was successful regardless of very low birthweight: in three cases, birthweight was under 1.000 g.(ABSTRACT TRUNCATED AT 250 WORDS)