Prophylactic indomethacin: Factors determining permanent ductus arteriosus closure

Narayanan, Meera; Cooper, Bruce A.; Weiss, Hali E.; Clyman, Ronald I.

doi:10.1067/mpd.2000.103414

Cited by 104 publications

(94 citation statements)

References 19 publications

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“…The role of indomethacin is well established; however, the best timing of therapy to prevent morbidity is still an unanswered question. Table 1 Contraindications to the administration of indomethacin 12 Active bleeding Active or suspected necrotizing enterocolitis Creatinine X2.0 mg/dl Urine output <0.6 ml/kg/h Platelet count <50 000 Active and untreated infection Suspected congenital heart disease Known gastrointestinal or renal anomaly …”

Section: Discussionmentioning

confidence: 99%

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Patent ductus arteriosus: pathophysiology and management

2006

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Patent ductus arteriosus (PDA) in preterm newborns prior to 28 weeks of gestation has led to many challenges regarding the type and timing of treatment regimens. A PDA results in increased pulmonary blood flow and redistribution of flow to other organs. Several co-morbidities (i.e., necrotizing enterocolitis, intracranial hemorrhage, pulmonary edema/ hemorrhage, bronchopulmonary dysplasia, and retinopathy) are associated with the presence of a PDA, but whether or not a PDA is responsible for their development is still unclear. The prostaglandin inhibitor, indomethacin, is effective in the treatment of PDA. Questions regarding the optimal timing of the intervention -early prophylaxis or treatment, once signs and symptoms become evident -have challenged physicians for decades. Both evidence and experience are explored in this article. Comparative physiology between the full-term and preterm newborn and the barriers preventing the necessary cascade of events leading to permanent constriction of the PDA are reviewed.

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Section: Discussionmentioning

confidence: 99%

“…11 An additional Doppler should be conducted after the sixth dose of indomethacin. 12 This Doppler reading will provide information about the likelihood of subsequent reopening. Table 1 lists the contraindications against indomethacin use.…”

Section: Clinical Findings and Associationsmentioning

confidence: 99%

Patent ductus arteriosus: pathophysiology and management

2006

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“…Although an initial indomethacin course will produce PDA closure in 60-80% of premature infants, the PDA reopens later in 6-53% of infants who initially respond to indomethacin [14,17,22,30]. There also appears to be no consensus regarding the best approach for the management of reopened PDA in premature infants, specifically for a PDA that reopens after the first 2 weeks of postnatal life [25,29].…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…In addition, randomized trials conducted to date have varied in their definition of ductal closure based on echocardiographic findings. These variations in echocardiographic definitions of ductal closure have relevance for the interpretation of response rates in the literature and the need for further treatment [10,13,14,20,26,28,32,33,35,37].Although an initial indomethacin course will produce PDA closure in 60-80% of premature infants, the PDA reopens later in 6-53% of infants who initially respond to indomethacin [14,17,22,30]. There also appears to be no consensus regarding the best approach for the management of reopened PDA in premature infants, specifically for a PDA that reopens after the first 2 weeks of postnatal life [25,29].…”

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confidence: 99%

Indomethacin Use for the Management of Patent Ductus Arteriosus in Preterms: A Web-Based Survey of Practice Attitudes Among Neonatal Fellowship Program Directors in the United States

2007

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The objective of this study was to determine whether neonatal-perinatal fellowship programs (NFTPs) in the United States vary in indomethacin use for the management of patent ductus arteriosus (PDA) in ≤28 week gestational age infants at birth. A 53-item web-based survey was sent to 84 NFTP directors who received prenotification, followed 2 weeks later by a reminder letter. A total of 56 NFTP directors responded (67% maximum response rate). Wide variation exists in the maximum number of indomethacin courses used to close ductus, use of indomethacin for reopened PDA beyond 14 days, ductal closure definition, contraindications before consideration of indo-methacin, interventions for contraindications, and reported ductal closer rate after each indomethacin course. Indomethacin therapy for symptomatic PDA and short course of indomethacin are common practices. Indomethacin use for the management of PDA in premature infants varies among NFTP directors. Practice attitudes may explain variations in ductal closure and ligation rates. Because practice variations may have implications for long-term outcome of vulnerable premature infants, studies relevant to the management of PDA in premature infants are needed. KeywordsIndomethacin; Health care surveys; Premature infants Patent ductus arteriosus (PDA) is extremely common, occurring in 50-75% of infants ≤28 weeks gestational age (GA) [19]. PDA is associated with increased risk of necrotizing © Springer Science+Business Media, LLC 2007 sanjiv_amin@urmc.rochester.edu. NIH Public Access Author ManuscriptPediatr Cardiol. Author manuscript; available in PMC 2015 January 06. Published in final edited form as:Pediatr Cardiol. 2007 ; 28(3): 193-200. doi:10.1007/s00246-006-0093-1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript enterocolitis, chronic lung disease, pulmonary hemorrhage, and intraventricular hemorrhage (IVH) [10,12,24,34]. Indomethacin is often used as a first line of treatment for PDA, with reported response rates greater than 60% in premature infants. However, studies have failed to provide conclusive results regarding the optimum duration, specifically short course (three dose) versus prolonged course (more than three doses) of indomethacin therapy [9,20,21,26,32,33,37]. Evidence is insufficient to support or refute the use of multiple courses (two or more courses) of indomethacin for the management of persistent PDA [23]. In addition, randomized trials conducted to date have varied in their definition of ductal closure based on echocardiographic findings. These variations in echocardiographic definitions of ductal closure have relevance for the interpretation of response rates in the literature and the need for further treatment [10,13,14,20,26,28,32,33,35,37].Although an initial indomethacin course will produce PDA closure in 60-80% of premature infants, the PDA reopens later in 6-53% of infants who initially respond to indomethacin [14,17,22,30]. There also appears to be no consensus regarding the best approach for the managem...

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“…1-2,4-5 The prevalence of sPDA as well as its responses to indomethacin treatment are influenced by numerous factors, namely GA and birth weight. 1,3,12 Spontaneous permanent closure of the ductus arteriosus occurred in less than 40% of infants born at p26 weeks and in more than 70% of those born at X30 weeks of gestation. 3,12 This wide variation in sPDA prevalence raises concern that unless a specific population of infants grouped by GA and birth weight are studied, the benefits of different management strategies will remain difficult to ascertain.…”

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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Prophylactic indomethacin: Factors determining permanent ductus arteriosus closure

Cited by 104 publications

References 19 publications

Patent ductus arteriosus: pathophysiology and management

Patent ductus arteriosus: pathophysiology and management

Indomethacin Use for the Management of Patent Ductus Arteriosus in Preterms: A Web-Based Survey of Practice Attitudes Among Neonatal Fellowship Program Directors in the United States

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

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