Factors determining reopening of the ductus arteriosus after successful clinical closure with indomethacin

Weiss, Hali E.; Cooper, Bruce A.; Brook, Michael M.; Schlueter, Mureen A.; Clyman, Ronald I.

doi:10.1016/s0022-3476(95)70084-6

Cited by 85 publications

(49 citation statements)

References 20 publications

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“…Kinoshita et al [1989] found from a pathological study that the major causes of death among patients with trisomy 18 were heart failure and pulmonary hemorrhage resulting from congenital heart defects. An echocardiographic study by Musewe et al [1990] and an autopsy study by Van Praagh et al [1989] suggested that early and excessive development of pulmonary hypertension, induced by congenital heart defects, might play a significant role in the premature death of some neonates with trisomy 13 or trisomy 18.…”

Section: Introductionmentioning

confidence: 99%

Intensive cardiac management in patients with trisomy 13 or trisomy 18

Kaneko

Kobayashi

Yamamoto

et al. 2008

American J of Med Genetics Pt A

112

115

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KEYWORDS trisomy 13 • trisomy 18 • neonate • congenital heart defects • neonatal intensive care • cardiac surgery ABSTRACTIntensive cardiac management such as pharmacological intervention for ductal patency (indomethacin and/or mefenamic acid for closure and prostaglandin E1 for maintenance) and palliative or corrective surgery is a standard treatment for congenital heart defects. However, whether it would be a treatment option for children with trisomy 13 or trisomy 18 syndrome is controversial because the efficacy on survival in patients with these trisomies has not been evaluated. We retrospectively reviewed 31 consecutive neonates with trisomy 13 or trisomy 18 admitted to our neonatal ward within 6 hr of birth between 2000 and 2005. The institutional management policies differed during three distinct periods. In the first period, both pharmacological ductal intervention and cardiac surgery were withheld. In the second, pharmacological ductal intervention was offered as an option, but cardiac surgery was withheld. Both strategies were available during the third period. The median survival times of 13, 9, and 9 neonates from the first, second, and third periods were 7, 24, and 243 days, respectively. Univariate and multivariate analyses confirmed that the patients in the third period survived significantly longer than the others. Intensive cardiac management consisting of pharmacological intervention for ductal patency and cardiac surgery was demonstrated to improve survival in patients with trisomy 13 or trisomy 18 in this series. Therefore, we suggest that this approach is a treatment option for cardiac lesions associated with these trisomies. These data are helpful for clinicians and families to consider in the optimal treatment of patients with these trisomies.

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Section: Introductionmentioning

confidence: 99%

Intensive cardiac management in patients with trisomy 13 or trisomy 18

Kaneko

Kobayashi

Yamamoto

et al. 2008

American J of Med Genetics Pt A

112

115

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“…Postnatally, many factors are known to influence the temporary or permanent closure of a ductus arteriosus. 6,25,26 More pertinent to our study, the antenatal use of indomethacin has been reported to increase the incidence of sPDA and decrease the response to postnatal indomethacin treatment. [7][8][9][10] Thus, it was conceivable that antenatal indomethacin could have also influenced negatively the responses to indomethacin prophylaxis.…”

Section: Discussionmentioning

confidence: 63%

“…Among the multiple factors known to decrease the response to postnatal indomethacin, GA and postnatal age at the time of treatment are the most relevant. 1,2,26 Satisfactory clinical response to indomethacin treatment of sPDA is expected to be 60% for 28 weeks GA 3 and about 50% for those ELBW infants at 24-25 weeks GA. 6 In the present study, successful indomethacin treatment of sPDA was noted in 16 of 30 (53%) and 13 of 29 (45%) study and control ELBW infants respectively.…”

Section: Discussionmentioning

confidence: 99%

The effects of indomethacin tocolysis on the postnatal response of the ductus arteriosus to indomethacin in extremely low birth weight infants

et al. 2006

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Background: Antenal indomethacin reportedly decreases the responses of a symptomatic patent ductus arteriosus (sPDA) to postnatal indomethacin treatment. Whether a similar exposure affects the responses to indomethacin prophylaxis is unknown.Objective: To evaluate the clinical responsiveness of ductus arteriosus to indomethacin prophylaxis and to the treatment of sPDA in extremely low birth weight (ELBW) infants following indomethacin tocolysis.Methods: Retrospective cohort study of 58 ELBW infants whose mothers received indomethacin tocolysis (study) and 58 ELBW infants whose mothers did not (controls), matched by gender, gestational age (GA), birth weight and postnatal sPDA management (prophylaxis or early treatment).Results: Indomethacin was used as a tocolytic at a median dose of 250 mg, for a duration of 2 days, and ending 1 day before delivery. Study and control mothers were comparable in demographics, antenatal steroid use, cesarean delivery, but were different in the incidence of preeclampsia and preterm labor. Study and control infants were similar in birth weight, GA, indomethacin prophylaxis, early sPDA treatment, mortality, necrotizing enterocolitis, severe intraventricular hemorrhage and stage 3-5 retinopathy of prematurity. Seventeen of 43 study and 16 of 43 control infants who received indomethacin prophylaxis developed sPDA and were combined with early treatment sPDA infants (15 to each group). Two of 32 study and two of 31 control infants underwent surgical ligation whereas the remaining were treated with indomethacin. Sixteen of 30 (53%) and 13 of 29 (45%) were successfully treated and did not require ligation. Study infants were divided according to their mothers' indomethacin total dose (28 infants received p225 mg and 30 infants received >225 mg). Both subgroups were demographically and clinically comparable and their response to indomethacin prophylaxis and treatment were similar. Conclusion:In ELBW infants, exposure to indomethacin tocolysis does not affect the clinical responsiveness of the ductus arteriosus to prophylaxis or that of the sPDA to indomethacin treatment.

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“…1,14,17 It is possible that in some preterm infants, whether spontaneously or indomethacin mediated, the ductus arteriosus frequently fails to develop the level of profound ischemia needed to cause remodeling, thus allowing the vessel to remain open, or if it is already closed, to reopen. 1,17,18 Satisfactory clinical responses to postnatal indomethacin treatment for sPDA are expected to be about 50% for infants at 24 to 25 weeks of GA and 60% or higher for those ELBW infants of older GA. 3,19 In the present study, successful indomethacin treatment of sPDA was noted in 38% of indomethacin prophylaxis infants and in 59% of those managed expectantly. It is possible that indomethacin prophylaxis, although failing to prevent an sPDA, may have preselected a group of infants that having failed once are predisposed to fail a second indomethacin treatment.…”

Section: Discussionmentioning

confidence: 99%

Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

et al. 2007

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Background: Indomethacin prophylaxis or expectant treatment are common strategies for the prevention or management of symptomatic patent ductus arteriosus (sPDA). Objective:To compare the clinical responses of extremely low birth weight (ELBW) infants to indomethacin prophylaxis with hat of other infants who were managed expectantly by being treated with indomethacin or surgically only after an sPDA was detected.Methods: Retrospective cohort investigation of 167 ELBW infants who received indomethacin prophylaxis (study) and 167 ELBW infants (control) treated expectantly who were matched by year of birth (1999 to 2006), birth weight, gestational age (GA) and gender.Results: Mothers of the two groups of infants were comparable demographically and on the history of preterm labor, pre-eclampsia, antepartum steroids and cesarean delivery. Study and control infants were similar in birth weight, GA, low 5 min Apgar scores, surfactant administration, the need for arterial blood pressure control, bronchopulmonary dysplasia and neonatal mortality. Necrotizing enterocolitis, spontaneous intestinal perforations, intraventricular hemorrhage grade III to IV, periventricular leukomalacia and stage 3 to 5 retinopathy of prematurity occurred also with similar frequency in both groups of infants. In the indomethacin prophylaxis group, 29% of the infants developed sPDA, and of them 38% responded to indomethacin treatment. In the expectantly treated group, 37% developed sPDA, and of them 59% responded to indomethacin treatment. Overall, surgical ligation rate for sPDA was similar between both groups of patients.Conclusion: In our experience, indomethacin prophylaxis does not show any advantages over expectant early treatment on the management of sPDA in ELBW infants. Although no deleterious effects were observed, prophylaxis exposed a significant number of infants who may have never developed sPDA, to potential indomethacin-related complications.

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Factors determining reopening of the ductus arteriosus after successful clinical closure with indomethacin

Cited by 85 publications

References 20 publications

Intensive cardiac management in patients with trisomy 13 or trisomy 18

Intensive cardiac management in patients with trisomy 13 or trisomy 18

The effects of indomethacin tocolysis on the postnatal response of the ductus arteriosus to indomethacin in extremely low birth weight infants

Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

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