Spontaneous Motility in Preterm Infants Treated with Indomethacin

Abstract

Objective: To determine in preterm infants with a patent ductus arteriosus (PDA) the effect of indomethacin treatment on spontaneous motor activity. Study Design: Motor activity was assessed from repeated videotape recordings in 32 preterm infants (≤33 weeks gestation). Sixteen infants required indomethacin therapy for treatment of PDA, 16 were control infants, matched for gestational age. Indomethacin (0.2 mg/kg i.v. in 5 min) was given thrice, with an interval of 12 h. One-hour recordings were made immediately before and immediately after the first dose of indomethacin and 24 h later before and after the third dose. The same recording schedule was used for the control infants. The effects of indomethacin on quantity and quality of spontaneous motor activity were examined. Results: A significant reduction in the quantity of several spontaneous movement patterns and an increase in the occurrence of rest periods were found following the first indomethacin administration (p < 0.01). Concerning the quality of general movements, a reduction in the speed was found (p < 0.05). Both effects were not found after the third indomethacin administration. Conclusion: In preterm infants with a PDA, treatment with indomethacin leads to a transient reduction in the quantity of spontaneous movement patterns and to a decrease in the speed of general movements. We recommend a cautious use of bolus indomethacin for the treatment of PDA.

Prechtl's assessment of general movements: A diagnostic tool for the functional assessment of the young nervous system

“…So far, 11 studies on 358 infants assessed by 90 observers revealed an agreement between 89% and 93% [Prechtl, 1990;Geerdink and Hopkins, 1993;Albers and Jorch, 1994;Bos et al 1997bBos et al , 1998aBos et al , 2000Cioni et al, 1997aCioni et al, , 1997cEinspieler et al, 1997Einspieler et al, , 2002Guzzetta et al, 2003]. The average kappa [Cohen, 1960] in another four studies on 108 infants assessed by 11 observers was 0.88 [van Kranen-Mastenbroek et al, 1992;Bos et al, 1997aBos et al, , 1998bCioni et al, 2000].…”

Cramped Synchronized General Movements in Preterm Infants as an Early Marker for Cerebral Palsy

“…The pattern of cramped synchronized GMs is the easiest to spot because all or most of the limbs contract and relax almost simultaneously with a monotonous sequence. The method has been widely accepted and recognized [29][30][31][32][33][34][35][36][37][38][39][40] as a simple, noninvasive, and powerful diagnostic and prognostic tool, and we think that assessment of spontaneous motility is a substantial part of the neurological examination. Medical staff involved in the neurological follow-up of high-risk newborn infants could benefit from the gestalt approach, which can be learned through specific training courses.…”

“…Moreover, substantial indications suggest that spontaneous activity is a more sensitive indicator of brain dysfunction than reactivity to sensory stimuli in reflex testing. Various studies [29][30][31][32][33][34][35][36][37][38][39][40] have demonstrated that in newborn…”

Continuous Indomethacin Infusion May Be Less Effective than Bolus Infusions for Ductal Closure in Very Low Birth Weight Infants

“…5,6 In addition, a reduction of the quantity and quality of the spontaneous motor repertoire is reported. 7 Recent studies indicate that cerebral, renal, and mesenteric blood flow is not impaired if INDO is administered as a continuous infusion, whereas ductal closure rates are reported to be similar. 8,9 Hence, we changed our protocol for ductal closure in December 2001 from bolus infusions to continuous INDO infusion.…”