Pharmacologic Closure of Patent Ductus Arteriosus in the Premature Infant

Friedman, William F.; Hirschklau, Michael J.; Printz, Morton P.; Pitlick, Paul T.; Kirkpatrick, Stanley E.

doi:10.1097/00006254-197702000-00002

Cited by 29 publications

(36 citation statements)

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“…Descriptions of induced ductal closure by non-steroidal anti-inflammatory drugs by Friedman et al 4 and Heymann et al 5 in 1976 were followed by numerous studies confirming that indomethacin and ibuprofen effect ductal constriction and closure, particularly during the first week after birth. These successes were followed by widespread adoption of aggressive measures to ensure early ductal closure in preterm infants.…”

mentioning

confidence: 99%

Patent ductus arteriosus: to treat or not to treat?

Benitz

2011

Arch Dis Child Fetal Neonatal Ed

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Persistent patency of the ductus arteriosus in the preterm infant is associated with numerous morbidities, including higher rates of bronchopulmonary dysplasia and increased mortality. These strong associations have led to widespread use of cyclooxygenase inhibitors and surgical ligation to achieve ductal closure in the expectation that closing the ductus will reduce these complications. Each of these interventions has its own associated adverse effects. Neither individual randomised controlled trials nor meta-analyses of those trials have been able to demonstrate longterm benefi ts of these treatments despite their effi cacy in inducing ductal closure and reducing the need for ductal ligation. Despite the potential shortcomings of those trials, they provide substantial cumulative evidence that early, routine treatment to close a persistently patent ductus arteriosus in preterm infants does not improve outcomes and should therefore be abandoned. Future trials of these interventions for patent ductus management should address different questions. Persistence of ductal patency should be considered a sign of rather than a direct cause of the several morbidities with which it is clearly associated. Practitioners should tolerate ductal patency and learn to manage its causes and consequences rather than focusing on achievement of ductal closure.

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confidence: 99%

Patent ductus arteriosus: to treat or not to treat?

Benitz

2011

Arch Dis Child Fetal Neonatal Ed

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“…Successful pharmacological closure of PDA with indometacin was first reported in 1976, and subsequent reports demonstrated that indometacin improved respiratory outcome and reduced morbidity 1 – 3. However, indometacin may lead to complications such as transient or permanent renal dysfunction,4 5 necrotising enterocolitis, gastrointestinal haemorrhage6 and reduced cerebral intracellular oxygenation 7 8.…”

mentioning

confidence: 99%

Comparison of ibuprofen and indometacin for early-targeted treatment of patent ductus arteriosus in extremely premature infants: a randomised controlled trial

Lin

Chiu

et al. 2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…(7) Long-term prognosis is still to be ascertained after clinical trials with this drug. (8) Indomethacin is effective in closing the ductus and a useful alternative to surgical ligation. (9) If it fails surgery should follow.…”

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confidence: 99%

Pharmacological closure of ductus arteriosus in preterm infants using indomethacin

Obeyesekere¹,

Pankhurst²,

Yu³

1980

Archives of Disease in Childhood

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SuMMARY Patent ductus arteriosus (PDA) was diagnosed in 27 (21 %) of 129 infants weighing < 1500 g at birth presenting over I years. The incidence of PDA in infants with pulmonary disease, particularly hyaline membrane disease, was higher than that in infants without such disease (31% compared with 16% Results suggest that (1) extremely preterm infants are less likely to respond to indomethacin, (2) success is more likely in the first 10 days of life, (3) a total dose greater than 0.6 mg/kg will not increase the success rate, (4) selective morbidity from indomethacin is unlikely ifthe contraindications of bleeding tendency, hyperbilirubinaemia, and renal dysfunction are followed, although urinary output must be monitored carefully, (5) indomethacin is a useful alternative to surgical ligation although long-term prognosis from clinical trials has yet to be established.

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Pharmacologic Closure of Patent Ductus Arteriosus in the Premature Infant

Cited by 29 publications

References 0 publications

Patent ductus arteriosus: to treat or not to treat?

Patent ductus arteriosus: to treat or not to treat?

Comparison of ibuprofen and indometacin for early-targeted treatment of patent ductus arteriosus in extremely premature infants: a randomised controlled trial

Pharmacological closure of ductus arteriosus in preterm infants using indomethacin

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