Minimal Effective Dose of Indomethacin for the Treatment of Patent Ductus arteriosus in Preterm Infants

Abstract

The aim of this study was to determine if it was possible to decrease the number of boluses of indomethacin for the treatment of patent ductus arteriosus. This retrospective study included 46 preterm neonates (<34 weeks’ GA) who had had an ultrasound diagnosis predictive of subsequent symptomatic patent ductus arteriosus. All patients had received a daily intravenous doses of indomethacin, 0.1 mg/kg. Mean age at initiation of treatment was 4.5 ± 3.1 days. Patency of the ductus arteriosus was controlled echocardiographically each day and treatment was discontinued as soon as the ductus arteriosus was closed. The initial success rate was 84.7%, of which 6.5% reopened. The mean cumulative dose of indomethacin was 0.35 mg/kg. There was no correlation between gestational age or birth weight and total cumulative dose. Overall tolerance was satisfactory with only one case of transient acute renal failure. A weak correlation between the cumulative dose of indomethacin and natremia (r = –0.43) or weight gain (r = 0.35) was noted, and none with serum creatinine or blood urea nitrogen levels. We confirm that lower indomethacin treatment of patent ductus arteriosus in premature neonates are as effective as standard protocols.

Myocardial Adaptation to Anemia and Red Blood Cell Transfusion in Premature Infants Requiring Ventilation Support in the 1st Postnatal Week

“…For left pulmonary arterial flow, the potential notched pattern was noted [13] . For the DA, the shunt pattern was classified as left-to-right, bidirectional, or right-to-left [14] . Pulmonary artery systolic pressure was estimated from ductal velocities.…”

Primer consenso clínico de SIBEN: enfoque diagnóstico y terapéutico del ductus arterioso permeable en recién nacidos pretérmino

“…El ductus está a menudo cerrado cuando se administra la segunda dosis 145 . Se ha usado vigilancia ecocardiográfica para limitar la duración del tratamiento con indometacina sin efectos adversos en las tasas de cierre 146,147 . Si se dispone de una amplia vigilancia ecocardiográfica, puede ser posible administrar tratamientos más cortos o de menos dosis, dependiendo de la respuesta individual evidenciada por ecocardiograma 148 .…”

“…Los hallazgos son controvertidos, sin embargo, no lo son en cuanto al efecto diferencial de la administración en bolo frente a la infusión lenta 107,113,144,230 . Parece que el efecto de la indometacina sobre la reducción de la perfusión cerebral podría ser más precoz en el bolo que en la infusión lenta 114 , si bien no existen diferencias en el efecto global o en la duración de éste si el período de observación es más prolongado 114,147 , pero el período de observación fue corto en dos estudios (30 y 60 min) 108, 224 . Administrando cada dosis durante más de 30-60 min parecen limitarse algunos de los efectos negativos sobre el flujo sanguíneo.…”

Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants

“…Traditionally, 3 doses of ibuprofen or indomethacin have been given at regular intervals. However, ductal closure is observed by the time the second or third dose is given12), hence, some investigators have used echocardiography-guided medical treatment to limit unnecessary exposure to cyclooxygenase inhibitors in preterm infants with PDA345).…”