Continuous infusion versus intermittent bolus doses of indomethacin for patent ductus arteriosus closure in symptomatic preterm infants

Görk, A. Semih; Ra, Ehrenkranz; Mb, Bracken

doi:10.1002/14651858.cd006071

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…54 In the Cochrane metaanalysis evaluating duration of indomethacin infusion, there has been no significant differences in the primary outcome of PDA closure at Day 2 (RR 1.57, 95% CI 0.54, 4.60) and at Day 5 (RR 2.77, 95% CI 0.33, 23.14), or for the secondary outcomes of reopening of PDA, neonatal mortality, IVH, and NEC between the two groups. 55 In view of the reduced renal side effects, it seems preferable to use continuous infusion of indomethacin over intermittent boluses.…”

Section: Bolus Vs Continuous Infusionmentioning

confidence: 99%

Management of Patent Ductus Arteriosus in Preterm Infants-Where Do We Stand?

Mitra

Rønnestad

Holmstrøm

2013

Congenital Heart Disease

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Patent ductus arteriosus (PDA) in preterm infants is a controversial topic in the management of preterm neonates. There are no generally accepted guidelines for diagnosis, treatment, and follow-up of PDA, and few publications have covered the whole topic or have been conclusively summarized to give a proper direction for the treating physician. Major issues remain to be clarified, both with respect to diagnosis and treatment. The definition of hemodynamic significance varies because of different use of echocardiographic criteria and uncertainty about the role of biomarkers. The detailed risks and benefits of available treatment alternatives are still under investigation. There has been a general shift in the management of PDA in preterm neonates from the "aggressive approach" to a more "conservative approach," but the effects of this strategy on morbidity in a longer time perspective are not fully known. An individualized therapeutic strategy with special emphasis on identification of hemodynamically significance seems to be the way forward. In this review we put forward the scientific background in favor of a seemingly growing body of evidence against active treatment, but we raise caution against shying away from all forms of treatment or instituting them too late. Finally, we try to integrate the current knowledge into suggestions for the management of PDA in premature infants.

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Section: Bolus Vs Continuous Infusionmentioning

confidence: 99%

Management of Patent Ductus Arteriosus in Preterm Infants-Where Do We Stand?

Mitra

Rønnestad

Holmstrøm

2013

Congenital Heart Disease

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“…Intravenous indomethacin is usually given as bolus over 30 min, only two small trials compared continuous with intermittent bolus administration and reported no statistically significant differences in PDA closure at day 2 or day 5, rates of reopening of PDA, neonatal mortality, IVH, and NEC [ 130 ].…”

Section: How To Treat?mentioning

confidence: 99%

Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

Abdel‐Hady

Nasef

Shabaan

et al. 2013

BioMed Research International

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Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs) to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS) PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.

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