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Intravenous indomethacin therapy in preterm neonates with patent ductus arteriosus

, : Intravenous indomethacin therapy in preterm neonates with patent ductus arteriosus. Journal of Paediatrics & Child Health 27(6): 370-375

This study examined the response of the patent ductus arteriosus (PDA) to intravenous idomethacin using serial two dimensional and Doppler echocardiography and documented the complications associated with therapy. Thirty-six preterm neonates who were oxygen and ventilator dependent were studied when they were aged 3-7 days. The PDA initially closed in 22 (61%) and constricted in seven (19%) of the infants. It was non-responsive in five (14%) and the treatment was stopped because of complications in two (6%). Only three (43%) of seven neonates given a second course had PDA closure. In the 25 instances where there was PDA closure following indomethacin, re-opening was documented echocardiographically on three (12%) occasions. Overall, indomethacin therapy was successful in 29 (81%) neonates, PDA ligation was required in four (11%) and three died from unrelated causes. Three (8%) neonates developed major complications: multiple gastric perforations in the first, focal ileal perforation in the second, and necrotizing enterocolitis in the third. Treatment failure, PDA ligation and major complications occurred exclusively in neonates < 28 weeks gestation. In view of the relatively low efficacy and high major complications rate in these extremely preterm infants, a randomized clinical trial needs to be conducted using two dimensional and Doppler echocardiography to allow accurate assessment of the PDA response to intravenous indomethacin.


PMID: 1756081

DOI: 10.1111/j.1440-1754.1991.tb00422.x

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