Effect of Antenatal Glucocorticoids on Clinical Closure of the Ductus Arteriosus

Prevalence of patent ductus arteriosus in premature infants at the Neonatal Ward, Cipto Mangunkusumo Hospital, Jakarta

“…4,11 Table 3 shows that in 42 infants whose mothers did not receive prenatal dexamethasone, 5 of 42 infants suffered from PDA. This result was lower than that reported by Waffarn et al 24 It was caused by the fact that in this study, not all of the subjects' mothers received corticosteroids prior to delivery.…”

Factors Associated With Permanent Closure of the Ductus Arteriosus: A Role for Prolonged Indomethacin Therapy

“…Both the increased use of antenatal steroids and the earlier use of indomethacin have increased the effectiveness of the standard 3-dose course of indomethacin in recent years. 1,2,12 We hypothesize that, in contrast with earlier studies, a significant proportion of the infants in the recent studies may have developed complete Doppler closure with just 3 doses of indomethacin (as occurred in 214 of the 313 infants treated with the standard 3-dose course in our study). Because the degree of ductus constriction seems to determine the rate of anatomic remodeling and permanent closure, [1][2][3][4] daily echocardiographic evaluations of ductal patency may be the best way to decide when indomethacin therapy is no longer needed.…”

Mechanisms Regulating the Ductus Arteriosus

“…During normal fetal development, circulating cortisol concentrations increase near the end of gestation. Elevated cortisol concentrations in the fetus have been found to decrease the sensitivity of the ductus to the vasodilating effects of PGE 2 [35] ; consistent with these fi ndings, prenatal administration of glucocorticoids causes a signifi cant reduction in the incidence of PDA in premature humans and animals [36][37][38][39][40] . The postnatal administration of glucocorticoids also has been shown to reduce the incidence of PDA [41] .…”