Document Detail


Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?
MedLine Citation:
PMID:  17251986     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 that 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.
Authors:
L Cordero; C A Nankervis; D Delooze; P J Giannone
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-01-25
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  27     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-22     Completed Date:  2007-04-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  158-63     Citation Subset:  IM    
Affiliation:
1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA. Leandro.cordero@osumc.edu
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MeSH Terms
Descriptor/Qualifier:
Cerebral Hemorrhage / epidemiology
Comorbidity
Ductus Arteriosus, Patent / epidemiology,  prevention & control*,  surgery
Female
Humans
Indomethacin / therapeutic use*
Infant, Newborn
Infant, Premature, Diseases / prevention & control*
Infant, Very Low Birth Weight*
Leukomalacia, Periventricular / epidemiology
Ligation
Male
Retrospective Studies
Tocolytic Agents / therapeutic use*
Chemical
Reg. No./Substance:
0/Tocolytic Agents; 53-86-1/Indomethacin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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