Prophylactic indomethacin therapy in the first twenty-four hours of life for the prevention of patent ductus arteriosus in preterm infants treated prophylactically with surfactant in the delivery room

Couser, Robert J.; Ferrara, Teresa; Wright, Gregory B.; Cabalka, Allison K.; Schilling, Craig G.; Hoekstra, Ronald; Payne, Nathaniel R.

doi:10.1016/s0022-3476(96)80127-2

Cited by 67 publications

(52 citation statements)

References 24 publications

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“…Alguns centros internacionais de perinatologia observaram que os RN com peso ao nascer menor do que 1.000 g que apresentam PCA logo no primeiro dia de vida apresentam um risco de 80% de desenvolverem sinais persistentes desse canal arterial 24 . Em um estudo prospectivo randomizado, realizado por Couser et al, foi utilizada indometacina de forma profilática, nas primeiras 24 horas de vida, em RN-PT que receberam surfactante na sala de parto, tendo se observado uma redução significativa do fluxo esquerdadireita através do canal arterial nessa população 25 .…”

Section: Discussionunclassified

Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus

Afiune¹,

Singer²,

Leone³

2005

J Pediatr (Rio J)

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Objective: To identify clinical and echocardiography predictors of the spontaneous closure of patent ductus arteriosus in preterm neonates.Methods: Sixty-one consecutive preterm neonates (gestational age 30±2 weeks, birth weight 1.2±0.2 kg) were evaluated by echocardiogram on their third day of life and those with patent ductus arteriosus were selected for a prospective cohort. Echocardiography was repeated weekly until they reached term. Based on their progress, the sample population was divided into two groups, depending on whether spontaneous closure of patent ductus arteriosus took place (Group A) or not (Group B). The prevalence of clinical signs of patent ductus arteriosus and echocardiography findings at baseline were compared between the groups.Results: Patent ductus arteriosus was found in 21 neonates (34%). Spontaneuous closure was observed during follow-up of seven patients (Group A, 33% of those with patent ductus arteriosus), in contrast with the remaining 14 patients (Group B, 67%). Clinical signs of patent ductus arteriosus were present in 14% of the patients in Group A, compared with 71% in group B (p = 0.01). At baseline, Group B had a larger ductus diameter in relation to Group A (2.6±0.6 mm vs. 1.4±0.6 mm; p = 0.003). The area under the ROC curve in relation to ductus diameter was 0.93 (p = 0.003) and 100% sensitivity for identifying cases without spontaneous closure was obtained at the cutoff point of 1.7 mm, while 100% specificity was observed taking 2.2 mm as the cutoff. Conclusions:In preterm neonates, a patent ductus arteriosus greater than 2.2 mm on the third day of life predicts no spontaneous closure and suggests a need for early treatment, especially when associated with clinical signs.J Pediatr (Rio J). 2005;81(6):454-60: Preterm neonates, echocardiography, patent ductus arteriosus. ResumoObjetivo: Analisar características ecocardiográficas e manifestações clínicas na evolução de recém-nascidos pré-termo com persistên-cia do canal arterial e identificar indicadores mais confiáveis do fechamento espontâneo deste.Métodos: Sessenta e um recém-nascidos pré-termo com idade gestacional de 30±2 semanas (26-34 semanas) peso de 1,2±0,2 kg (0,7-1,7 kg) foram avaliados semanalmente desde o terceiro dia de vida até o termo através de ecocardiograma. O diâmetro do canal arterial e medidas das cavidades cardíacas foram determinados. Avaliação clínica procurou detectar sinais clínicos de persistência do canal arterial. Recém-nascidos pré-termo com persistência do canal arterial foram divididos em dois grupos: Grupo A, onde houve fechamento espontâneo do canal arterial, e Grupo B, onde não houve. Análise estatística foi realizada através do teste t e curva ROC.Resultados: Vinte e um (34,4%) recém-nascidos pré-termo apresentaram persistência do canal arterial no terceiro dia de vida, sendo sete do grupo A e 14 do grupo B. Sinais clínicos de persistência do canal arterial ocorreram em 14,3% do grupo A e 71,4% do grupo B (p = 0,013). Persistência do canal arterial aumentou significativamente os...

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Section: Discussionunclassified

Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus

Afiune¹,

Singer²,

Leone³

2005

J Pediatr (Rio J)

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“…9,32,33 Similarly, a recent population-based investigation from Israel did not find an increased risk of NEC secondary to indomethacin exposure. 34 However, these investigators did identify that a PDA was an independent risk factor for NEC.…”

Section: Prenatal Indomethacin Exposurementioning

confidence: 97%

Prenatal or postnatal indomethacin exposure and neonatal gut injury associated with isolated intestinal perforation and necrotizing enterocolitis

et al. 2010

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Objective: To examine the role of indomethacin in neonatal gut injury.Study Design: Infants born at gestational age X23 weeks and with birth weights 400-1200 g were included in this prospective prevalence study of neonatal gut injury. Infants with isolated intestinal perforation (IIP) confirmed at laparotomy or at autopsy or with necrotizing enterocolitis (NEC) were identified. Data were abstracted bi-weekly.Result: Among 992 study infants, 58 infants exposed solely to prenatal indomethacin did not show an increased rate of neonatal gut injury. Any postnatal indomethacin exposure (n ¼ 611) increased the odds of IIP (OR 4.17, CI, 1.24-14.08, P ¼ 0.02) but decreased the odds of NEC (OR 0.65, CI 0.43-0.97, P ¼ 0.04). There was a negative association between the timing of indomethacin-exposure and the odds of developing IIP (OR 0.30, CI 0.11-0.83, P ¼ 0.02). Compared with NEC, IIP occurred at an earlier age (P<0.05) and was more common (P<0.05) among infants who received early indomethacin (first dose at <12 h of age) to prevent intraventricular hemorrhage than among infants who were treated with late indomethacin for closure of a patent ductus arteriosus (PDA). Unlike the classic hemorrhagic ischemic lesions of NEC in which large areas of tissue were inflamed or necrotic, the IIP lesions were small and discrete.Conclusion: Early (<12 h) postnatal indomethacin exposure was associated with an increased odds of IIP in very low birth weight infants whereas its later use for closure of a PDA appeared to provide protection against NEC. The paradoxical effect of the timing of indomethacin on IIP versus on NEC may be related to the different pathogeneses of the two diseases. Our findings also suggest that PDA may contribute to NEC.

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“…A reduction in cerebral palsy in one small (27 subjects) trial of indomethacin prophylaxis 95 was not confirmed in two larger studies. 100,106 No trial showed beneficial impacts on pulmonary hemorrhage, 96,99,102,103,106 severe pulmonary hemorrhage, 110 PVL, 83,84,86 -89,95,96,100,101,103,107 any ROP 62,64,72 -74,76,84,85,89,90,95,96,105,106 or ROPXstage 2 84 or stage 3, 89,96,111 Bailey mental developmental index 79,96,106 or psychomotor developmental index, 79,96 mean Wechsler Preschool and Primary Scale of Intelligence, revised scores, 112 severe developmental delay, 96,100,106 or neurosensory impairment or neurosensory impairment or death. 96,103,106 In summary, individual randomized-controlled trials provide scant evidence of benefit from prophylaxis or treatment of PDA in preterm infants.…”

Section: Findings From Individual Randomized-controlled Trialsmentioning

confidence: 99%

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

2010

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Prophylactic indomethacin therapy in the first twenty-four hours of life for the prevention of patent ductus arteriosus in preterm infants treated prophylactically with surfactant in the delivery room

Cited by 67 publications

References 24 publications

Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus

Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus

Prenatal or postnatal indomethacin exposure and neonatal gut injury associated with isolated intestinal perforation and necrotizing enterocolitis

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

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