Indomethacin therapy for large patent ductus arteriosus in the very low birth weight infant: results and complications
Halliday, H.L.; Hirata, T.; Brady, J.P.
Pediatrics 64(2): 154-159
1979
ISSN/ISBN: 0031-4005 PMID: 471605 Document Number: 140012
Of 36 very low birth wt infants (< 1500 g) with large patent ductus arteriosus, 24 (67%) showed satisfactory constriction or closure after indomethacin therapy (mean total dose 0.4 mg/kg). Twelve infants (33%) responded inadequately with 7 infants requiring surgical ligation. Response was better in infants 8-14 days old compared to those more than 14 days old (89% vs. 33%, P = .048) irrespective of birth wt or gestational age. Major complications were renal and unrelated to ductus response. Urine output fell significantly (3.65 to 1.63 ml/kg per h, P < .001) and in 47% of infants serum creatinine increased .gtoreq. 1.5 mg/dl. Creatinine was less likely to rise in infants more than 14 days old. Hyponatremia was found in 36% of infants. Serum K increased more frequently in infants more than 8 days old and was > 6.0 meq/l in 25%. Indomethacin caused a reduction in PaCO2 (41 to 37 mm Hg, P < .01) and an increase in pH (7.32 to 7.36, P < .02) with no change in base deficit. These changes occurred even in the absence of clinical ductus closure. No other side effects of indomethacin therapy were noted. Three infants died but death was unrelated to indomethacin therapy. Overall survival was 92%, and 9 infants (25%) developed mild bronchopulmonary dysplasia.