Echocardiography Cuts Indomethacin Use for Patent Ductus Arteriosus
Last Updated: 2009-12-25 10:30:07 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Echocardiography can help limit indomethacin exposure in preterm neonates being treated for hemodynamically significant patent ductus arteriosus, Australian researchers report in the December issue of the Journal of Pediatrics.
"Whether or not we need to treat the preterm ductus arteriosus remains controversial," lead investigator Dr. Kathryn B. Carmo, of the University of Sydney, told Reuters Health by email.
The treatment's side effects include decreased renal, splanchnic, and cerebral blood flow. "This study shows that you can give a lesser dose of a potentially harmful drug and achieve similar closure rates of the patent ductus arteriosus," Dr. Carmo continued.
Dr. Carmo and colleagues studied 74 infants with a gestational age of less than 30 weeks and a patent ductus arteriosus of more than 2 mm in diameter.
They were all evaluated by echocardiography in the first 12 hours of life and treated with indomethacin 0.1 mg/kg. All then underwent echocardiography every 24 hours for four days, and again on days 7, 14, and 28.
After the first indomethacin treatment, the infants were randomized to two groups: One received standard treatment, which consisted of further 01.mg/kg doses every 24 hours, regardless of echocardiographic findings. The echocardiographic-dependent dose group only received indomethacin as long as the patency was greater than 1.6 mm.
At 72 hours of life, 25% of both groups still had patent ducts. There were also no significant differences in reopening or need for surgical ligation.
Most of the infants (65%) in the echocardiographic-dependent dose group received 1 dose of indomethacin, while only one (2.5%) in the standard group required just a single dose. The median number of doses was one in the echocardiographic-dependent dose group, and three in the standard group.
The researchers conclude that the approach is effective in achieving closure and "offers the potential for dose minimization."
The study "provides valuable preliminary information in the search for a more selective early treatment modality of patent ductus arteriosus in very preterm neonates," write Drs. Shahab Noori of the University of Oklahoma Health Sciences Center, Oklahoma City and Istvan Seri of the University of Southern California, Los Angeles, in an accompanying editorial.
J Pediatr 2009;155:819-822.
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