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[Renal effects of prolonged indomethacin therapy in premature infants]
J B Gouyon1, M Chouchane, M Françoise
1Service de pédiatrie 2, hôpital d'Enfants, Dijon, France.
Insights
Prolonged indomethacin therapy for patent ductus arteriosus in preterm infants did not prevent renal side effects. Renal function and water excretion were significantly impaired, indicating risks with longer treatment durations.
Area of Science:
- Neonatalogy
- Pharmacology
- Pediatric Nephrology
Context:
- Patent ductus arteriosus (PDA) is a common condition in preterm infants.
- Indomethacin is a standard treatment for PDA, but its optimal duration and renal effects are debated.
- Prolonged indomethacin therapy (5-6 days) is considered for improved efficacy in large PDAs.
Purpose:
- To evaluate the effects of prolonged indomethacin therapy (5-6 days) on renal function in preterm infants with symptomatic PDA.
- To compare renal function parameters before and during extended indomethacin treatment.
Summary:
- Seven preterm infants received indomethacin for 5 or 6 days.
- Significant decreases in urinary water excretion, water output/input ratio, and creatinine clearance were observed.
- Increases in serum creatinine and body weight, with stable sodium levels, indicated renal impairment.
Impact:
- Prolonged indomethacin therapy does not mitigate the renal side effects associated with shorter treatment durations.
- Findings suggest careful monitoring of renal function is necessary during extended indomethacin treatment for PDA.
- Highlights the trade-off between PDA closure efficacy and potential renal toxicity in neonates.
Background:
Indomethacin therapy for large patent ductus arterious would be more effective when it is prescribed for 5 or 6 days vs 2 or 3 days. Effects on renal function of such prolonged therapy is still debated.
Patients And Methods:
Seven preterm infants (gestational age: 28.6 +/- 0.9 weeks; birth-weight: 1,169 +/- 267 g) with symptomatic patent ductus arterious were given indomethacin, 0.1 mg/kg/day for 6 days (four patients) and 5 days (three patients). Urinary water excretion, water output/input ratio, creatinine clearance and body weight were measured before and every day during therapy.
Results:
Urinary water excretion, water output/input ratio and creatinine clearance were significantly decreased after 5 days of treatment, -40 +/- 30%, -42 +/- 27% and -48 +/- 31%, respectively. Creatinemia and body weight were significantly increased, + 34 +/- 36% and + 9 +/- 7%, respectively. Mean sodium plasma level and fractional excretion of sodium, potassium and chloride remained stable.
Conclusion:
Prolonged therapy with indomethacin does not avoid the renal side effects seen with shorter administration.