Increased Indomethacin Dosing for Persistent Patent Ductus Arteriosus in Preterm Infants: A Multicenter, Randomized, Controlled Trial

Jegatheesan, Priya; Ianus, Vlad; Buchh, Basharat; Yoon, Grace; Chorne, Nancy; Ewig, Audrey; Lin, Emil T.; Fields, Scott; Moon-Grady, Anita J.; Tacy, Terri; Milstein, Jay M.; Schreiber, Michael D.; Padbury, Jamés F.; Clyman, Ronald I.

doi:10.1016/j.jpeds.2008.01.031

Cited by 59 publications

(25 citation statements)

References 37 publications

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“…8,29 In addition, use of indomethacin to close PDA might reduce retinal blood flow and contribute to ROP development. 8,30 Dilated fundal examination in ROP screening is a stressful event for premature infants. It is important to screen only those who are at risk to avoid unnecessary examination and stress.…”

Section: Discussionmentioning

confidence: 99%

Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong

Lai

Fan

et al. 2016

Hong Kong Med J

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Section: Discussionmentioning

confidence: 99%

Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong

Lai

Fan

et al. 2016

Hong Kong Med J

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“…There was no difference in the incidences of renal or electrolyte abnormalities, gastrointestinal bleeding, IVH, and PVL when high dose was compared with the conventional one. Jegatheesan et al [129] had tried higher doses of indomethacin after failure of conventional doses and they found little effect on duct closure together with more adverse effects.…”

Section: How To Treat?mentioning

confidence: 99%

Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

Abdel‐Hady

Nasef

Shabaan

et al. 2013

BioMed Research International

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Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs) to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS) PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.

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“…Darlow et al (260) reported that infants treated with indomethacin were 1.5 times more likely to have ROP than untreated infants. Another study involving 105 preterm infants <28 weeks gestation who received low versus high indomethacin showed a significant increase in the incidence of moderate/severe ROP which was directly related to the indomethacin serum concentrations (261). Conversely, a retrospective chart review found that indomethacin use for PDA was protective for ROP (262).…”

Section: Drugs Associated With Incidence Of Ropmentioning

confidence: 99%

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

Beharry

Valencia

Lazzaro

et al. 2016

Seminars in Perinatology

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Retinopathy of prematurity (ROP), a significant morbidity in prematurely born infants, is the most common cause of visual impairment and blindness in children and persists till adulthood. Strict control of oxygen therapy and prevention of intermittent hypoxia are key in the prevention of ROP, but pharmacologic interventions have decreased risk of ROP. Various drug classes such as methylxanthines (caffeine), VEGF inhibitors, anti-oxidants, and others have decreased ROP occurrence. The timing of pharmacologic intervention remains unsettled, but early prevention rather than controlling disease progression may be preferred. These drugs act through different mechanisms and synergistic approaches should be considered to maximize efficacy and safety.

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Increased Indomethacin Dosing for Persistent Patent Ductus Arteriosus in Preterm Infants: A Multicenter, Randomized, Controlled Trial

Cited by 59 publications

References 37 publications

Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong

Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong

Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

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