use of indomethacin and other methods of management of premature infants with delayed closure of the ductus arteriosus

ABSTRACT

Patent ductus arteriosus [PDA] is observed much more commonly in premature than in mature infants. In premature infants of weight less than 1500g with respiratory distress syndrome [RDS], the PDA may be silent and yet be the cause of cardiac failure and aggravate the respiratory difficulties. The high incidence of PDA in premature infants is thought to be due to its own immaturity. In the mid 1970s it was suggested that indomethacin, a potent prostaglandin synthetase inhibitor, might have clinical applications in the non-surgical treatment of PDA in sick premature infants with RDS. Several reports have confirmed this drug's effectiveness in successful closure of 80% of PDAs in infants to whom it was administered; fluid restriction and diuretics also play a major role. The risks of indomethacin treatment include gastrointestinal bleeding, nephrotoxicity, liver toxicity, bone marrow depression, intracranial bleeding, necrotizing enterocolitis and retinopathy of prematurity. Fortunately these problems are rare but the drug should be used with caution, especially in infants of under 1000 g birth weight