Effect of Indomethacin Treatment in Full-term Infants with Symptomatic Patent Ductus Arteriosus / 대한주산의학회잡지

PURPOSE: Indomethacin has been reported as the prophylaxis and initial treatment of preterm infants with patent ductus arteriosus (PDA). However, there was controversy over indomethacin treatment in full-term infants with symptomatic PDA. Therefore, we evaluate the effect of indomethacin as a treatment of full-term infants with symptomatic PDA. METHODS: A retrospective study was performed to evaluate the effectiveness of indomethacin in full-term infants who had birth weight > or =2,500 g and a gestational age > or =37 weeks with symptomatic PDA at Chonnam National University Hospital between January 2007 and December 2009. According to responsiveness of indomethacin, we classified them into three groups: 1) complete responder which were completely closed after indomethacin treatment, 2) partial responder which were incompletely closed but symptoms were improved, 3) non responder which were conducted surgical ligation because did not respond. RESULTS: Among the total 29 full-term infants treated with indomethacin, 13 (44.8%) were complete responder, 8 (27.6%) were partial responder, and 8 (27.6%) were non responder. There were no significant differences in birth weight, narrow diameter of PDA, and dose of indomethacin between three groups. However, the age at initiation of treatment using indomethacin of complete (4.8+/-4.5 days, P=0.03) and partial responder (6.3+/-2.0 days, P=0.04) were earlier than those of non responder (13.8+/-8.1 days). CONCLUSION: Indomethacin can expect an effective treatment of PDA in full-term infants prior to surgical ligation.

Intracranial hemorrhage in full-term neonates by ultrasonography

Intracranial hemorrhage is the most common neuropathologic finding in premature infants. But in full-term infants, it is less common and rarely causes death. We found out intracranial hemorrhages in 21 full-term neonates by real-time neurosonography and concluded as followings. 1) Among 21 neonates, 17 infants were male and 4 infants were female. 2) In 11 (52.3%) infants the hemorrhage was detected within 7 days after birth. 3) The intracranial hemorrhage was not related with delivery type nor Apgar score. 4) In 13 cases (61.9%) the hemorrhage was in the subependymal germinal matrix and the degree was Grade I. 5) Precipitating or associated factors were asphyxia, pneumonia, ventilator care, RDS and congenital heart disease. 6) Symptoms and signs were seizure, apnea, lethargy, cyanosis, jaundice, anemia or bulging fontanel.