Summaryvreterm infants have not led to conclusive results (2. 8. 15). This Patency of the ductus arteriosus in preterm infants is mediated by vasodilating prostanoids; however, reliable methods to monitor prostanoid activity or production in preterm infants are lacking. We measured the excretion rates of major and characteristic urinary metabolites of prostacyclin (PG12), PGEl, and PGE2, 6-keto-PGF1,, and 7cr-hydroxy-5,ll-diketotetranorprostane-1,16-dioic acid (PGE-M), respectively. Besides these parameters which reflect total body prostanoid turnover and production, the urinary levels of PGE2 and PGFz,, the primary prostaglandins, were measured as an index of renal prostanoid synthesis. There were four study groups. One contained 11 thriving preterm infants; a second, six preterm infants with respiratory distress syndrome (RDS); a third, 30 preterm infants with RDS and patent ductus arteriosus (PDA); and a fourth, nine fullterm infants. All infants with RDS required artificial ventilation. There were no significant differences in PGE-M, PGE2, and PGF2, excretion rates among the various groups; however, a significant increase of the 6-keto-PGF,, excretion rates was observed in the groups of infants with RDS and with and without PDA (P < 0.01 and P < 0.02, respectively). Spontaneous (n = 2) or indomethacin-induced (n = 6) closure of PDA was associated with weaning from the respirator and a concomitant drop into the normal and subnormal range of the excretion rates of 6-keto-PGF,, ( P < 0.01) and PGE-M ( P < 0.02).Abbreviations GC-MS, gas chromatography-mass spectrometry PDA, patent ductus arteriosus PG, prostaglandin PGE-M, 7cu-hydroxy-5,ll-diketotetranorprostane-l,16-dioic acid PG12, prostacyclin RDS, respiratory distress syndrome There is increasing evidence that persistent PDA in preterm infants with RDS is mediated by vasodilating prostanoids (4, 18). But it is still a matter of debate whether increased prostanoid production or increased prostanoid sensitivity of ductal tissue is the major cause of PDA persistence in preterm infants with RDS (2, 3). It is not known whether PGIz or PGE,, both vasodilating prostanoids, is the actual mediator of ductal dilation in these infants. Nor is it known which organ or tissue is mainly involved in the production of these prostanoids.Several attempts to assess prostanoid activity by radioimmunologic determinations of PGE2 in the peripheral circulation of is not unexpected due to the numerous drawbacks related to measurements of primary (parent) PGs (1 1). There are four major concerns of this approach. 1) Very low circulating levels of primary PGs are expected because of the very rapid metabolism of these compounds and single blood measurements might easily miss rapid fluctuation of PG release. 2) Primary PGs might be released from platelets and white cells during collection and handling of blood samples. 3) Protein binding of prostanoid in blood and plasma may interfere with several conventional extraction procedures. 4) Radioimmunologic assays of prostanoids may lack the...