Related Experiment Videos
Prolonged low-dose indomethacin therapy for patent ductus arteriosus in very low birthweight infants
Insights
Prolonged low-dose indomethacin effectively treats hemodynamically significant patent ductus arteriosus in very low birthweight infants, with mild side effects. Caution is advised for critically ill infants under 1000g with bowel ischemia signs.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is common in very low birthweight (VLBW) infants.
- Hemodynamically significant PDA (hsPDA) can lead to serious complications.
- Indomethacin is a common treatment for hsPDA.
Purpose of the Study:
- To evaluate the efficacy of prolonged low-dose indomethacin for hsPDA in VLBW infants.
- To assess the side-effect profile of this treatment.
- To identify risks in specific infant populations.
Main Methods:
- Retrospective and prospective study of VLBW infants over 16 months.
- Echocardiography (M-Mode, pulsed-wave, color Doppler) used to diagnose hsPDA.
- Analysis of indomethacin treatment success, recurrence, and complications.
Main Results:
- 41% of VLBW infants had hsPDA.
- Indomethacin achieved 90% success after one course, 95% after two.
- Minor, transient side effects (oliguria, urea retention, hyponatraemia, thrombocytopenia) were observed.
- Gastrointestinal pathology incidence was not significantly higher than in controls.
Conclusions:
- Prolonged low-dose indomethacin is highly effective with a low recurrence rate for hsPDA in VLBW infants.
- Observed side effects were generally mild and transient.
- Caution is recommended for critically ill infants <1000g with hsPDA and signs of bowel ischemia.
Objective:
To determine the efficacy and side-effects of prolonged low-dose indomethacin therapy in very low birthweight (VLBW; < 1500 g) infants with a haemodynamically significant patent ductus arteriosus (hsPDA).
Methodology:
Very low birthweight infants admitted over a 16 month period were studied (8 months, retrospectively and 10 months, prospectively). Cross-sectional and M-Mode echocardiograms with pulsed-wave and colour Doppler were performed to assess the significance of ductal patency.
Results:
Forty-one (28%) of 148 VLBW infants were diagnosed to have hsPDA. Indomethacin therapy was successful in 90% after the first course, increasing to 95% after the second course. The recurrence rate after the first course was 3%. Minor and transient complications included oliguria, urea retention, hyponatraemia and thrombocytopenia. Although three infants had focal bowel perforation and the fourth had bowel perforation associated with necrotizing enterocolitis, the incidence of gastrointenstinal pathology was not significantly different from infants without hsPDA and not given indomethacin.
Conclusions:
Very low birthweight infants with hsPDA have a high response rate and low recurrence rate to prolonged low-dose indomethacin therapy. Side-effects were mild and transient. However, it is prudent to be cautious when administering indomethacin in critically ill infants < 1000 g with hsPDA who manifest clinical features of bowel ischaemia.