Relationship between Circulating Platelet Counts and Ductus Arteriosus Patency after Indomethacin Treatment

Abstract

Objective To determine if low platelet counts are related to the incidence of patent ductus arteriosus (PDA) after indomethacin treatment in preterm human infants. Study design Multivariable logistic regression modeling was used for a cohort of 497 infants, who received indomethacin (within 15 hours of birth). Results Platelet counts were not related to the incidence of permanent closure following indomethacin constriction. There was a relationship between platelet counts and the initial degree of constriction; however, this relationship appeared to be primarily influenced by the high end of the platelet distribution curve. PDA incidence was similar in infants with platelet counts <50 × 109/L and those with platelet counts above this range. Only when platelet counts were consistently >230 × 109/L was there a decrease in PDA incidence. Conclusion In contrast to the evidence in mice, low circulating platelet counts do not affect permanent ductus closure (or ductus reopening) in human preterm infants.

Platelet Counts in the First Seven Days of Life and Patent Ductus Arteriosus in Preterm Very Low-Birth-Weight Infants

“…Therefore, rather than finding higher rates of PDA among infants with the lowest platelet counts, they found that the relationship between the incidence of PDA and platelet counts appeared to be primarily influenced by the high end of the platelet distribution curve. However, it should be noted that the study of Shah et al [11] is not comparable with our study and the above-mentioned studies since the closure of the DA was influenced by the use of prophylactic indomethacin.…”

“…Whether this is also the case in human infants remains controversial [8,9,10,11,12]. Our data show that in a cohort of preterm VLBW infants the median platelet count nadir and the rate of mild, moderate or severe thrombocytopenia - within the first 2 days of life - were not significantly associated with the presence of HSPDA on day 3.…”

“…The rate of failure of COX inhibitor treatment was low (4.7%) and, unfortunately, the possible role of platelet counts in this failure was not analyzed. Shah et al [11] examined a cohort of 497 infants with gestational age <28 weeks who were managed in a single center with prophylactic indomethacin, echocardiographic assessment of DA status on day 3, additional indomethacin treatment in case of PDA, and second echocardiographic assessment on day 7. They observed that PDA was not related to low platelet counts in the first 7 days of life.…”

“…In a logistic regression model, a platelet count ≤150 × 10 9 /l was identified as an independent predictor of hemodynamically significant PDA (HSPDA). Several investigators [8,9] have confirmed the findings of Echtler et al [7], whereas others produced discordant observations which do not suggest that early thrombocytopenia consistently results in HSPDA [10,11,12,13]. Additional series of patients are required to resolve this controversy.…”

IV Paracetamol for closure of patent ductus arteriosus in preterm neonates admitted to a tertiary care centre

“…[14][15][16] Moreover, the complication is high and carries significant contraindications. [17][18][19][20][21][22] When drug fails or contraindicated, next option is surgery. But surgery carries significant mortality and morbidity.…”