[Effects of early therapy with indomethacin on the manifestation of a persistent ductus arteriosus in extremely underweight premature infants]

Abstract

In a randomized study the effect of an early prophylactic indomethacin treatment on the incidence of the patent ductus arteriosus (PDA) in very low birth weight infants (VLBWI) and their postnatal course were investigated. 19 VLBWI (weight 1221 +/- 158 g, gestational age 28.2 +/- 1.3 weeks) received 0.2 mg/kg indomethacin 3 times p.o. in 12 h intervals beginning on the 3rd day of life. 22 VLBWI with comparable weight (1250 +/- 154 g, gestational age 28.4 +/- 1 weeks), mode of delivery and postnatal adaptation served as controls. PDA was diagnosed clinically and by a decreased ratio of the systolic time intervals preejection period (PEP)/left ventricular ejection time (LVET) less than 0.3. PDA were seen in 7 indomethacin treated VLBWI and in 13 newborns of the control group. A symptomatic PDA developed in 4 infants of the latter group only. The indomethacin group was characterized by an increased ratio PEP/LVET from day 3 to 5 as an evidence for a diminished ductal shunt. Their weight loss was 3% lower and they regained their birth weight 5 days earlier. Otherwise, there were no differences in mortality and morbidity. Despite the proven efficacy of an early indomethacin treatment its use is recommended only for infants with a high risk for a PDA substantiated by a low ratio PEP/LVET less than or equal to 0.24 at the 3rd day of life.