| Persistent Doppler flow predicts lack of response to multiple courses of indomethacin in premature infants with recurrent patent ductus arteriosus. | |
| | |
MedLine Citation:
|
PMID: 12949288 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: Although indomethacin produces ductus arteriosus constriction in extremely premature newborns, a recurrent symptomatic patent ductus arteriosus (PDA) frequently develops after the initial course of indomethacin. Currently, there is little information available to determine the effectiveness of a second course of indomethacin in producing permanent ductus closure. The objective of this study was to determine the rate of permanent ductus closure after a second course of indomethacin for a recurrent, symptomatic PDA and to identify the factors associated with permanent ductus closure. METHODS: We identified 32 infants (<28 weeks' gestational age) 1) whose ductus was considered to be clinically closed after an initial course of indomethacin and 2) who subsequently developed a symptomatic PDA and received a second course of indomethacin. Clinical variables were evaluated for their association with failure of the second course (defined as surgical ligation after the second course for recurrence of a hemodynamically significant PDA). Data were analyzed by chi(2) analysis, Fisher's exact test, and the Mann-Whitney rank sum test. RESULTS: After the second course of indomethacin, 56% (18 of 32) of the infants had persistent or recurrent PDA-related symptoms that were considered to be hemodynamically significant. The only significant predictor of failure of the second indomethacin course was the demonstration (by Doppler echocardiogram) of persistent ductus flow within 24 hours of completing the initial indomethacin course. All of the 9 newborns with persistent Doppler ductus flow after the initial indomethacin course failed the second course of indomethacin. In contrast, only 39% (9 of 23) of newborns with absent Doppler flow after the initial indomethacin course failed the second course of indomethacin. CONCLUSIONS: Newborns who are <28 weeks' gestational age and develop a recurrent, symptomatic PDA after completion of an initial indomethacin course rarely respond to multiple courses of indomethacin if there was persistent Doppler evidence of ductus flow after completion of the initial course. Additional indomethacin treatment is unlikely to produce permanent ductus closure. |
| | |
Authors:
|
Roberta L Keller; Ronald I Clyman |
Related Documents
:
|
12971028 - Pharmacokinetics of oral ibuprofen in premature infants. 15861198 - Outcome of very low birth weight infants exposed to antenatal indomethacin for tocolysis. 9165518 - Unexpected recovery in a newborn with severe hypomyelinating neuropathy. 753168 - Operation or indomethacin for the premature ductus. 10390288 - Rehospitalization in the first two weeks after discharge from the neonatal intensive ca... 14712948 - Findings on potential teratogens from a case-control study in western australia. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
|
Title: Pediatrics Volume: 112 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2003 Sep |
Date Detail:
|
Created Date: 2003-09-01 Completed Date: 2003-10-24 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
|
Languages: eng Pagination: 583-7 Citation Subset: AIM; IM |
Affiliation:
|
Department of Pediatrics, University of California, San Francisco 94143, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Ductus Arteriosus, Patent
/
drug therapy*,
ultrasonography* Echocardiography, Doppler, Color* / methods Hemodynamics / drug effects, physiology Humans Indomethacin / therapeutic use* Infant Infant, Newborn Infant, Premature* Infant, Premature, Diseases / drug therapy, ultrasonography Predictive Value of Tests Recurrence Treatment Failure Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
|
HL 46691/HL/NHLBI NIH HHS; HL 56061/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
|
53-86-1/Indomethacin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Percutaneous lidocaine administration via a new iontophoresis system in children: tolerability and a...
Next Document: Longitudinal changes in growth parameters are correlated with changes in pulmonary function in child...