Efficacy of Indomethacin in Pharmacological Closure of PDA in Preterm Neonates: A Prospective Study from Tertiary Care Centre in Rural India

Sunil Sable, Rachna Sable, Amol Pokharkar, D.Y. Shrikhande

Abstract


Background: Patent ductusarteriosus (PDA) is a fetal shunt necessary for intrauterine survival of the baby, however its closure at birth occurs as pulmonary vascular resistance drops and lungs get expanded for participating in ventilation. However, PDA remains patent in a large proportion of preterm babies and by day -7, 87% of babies <24 wk gestation have a PDA which hinders in ventilation and causes ductal steal to vital organs. Hence, we aimed to study pharmacological closure of ductus in preterm babies. Aims and Objectives: 1) To study the efficacy of COX inhibitor, Indomethacin in ductal closure in preterm babies <34 wk gestation. 2) To compare the symptomatology of PDA in different groups of preterm babies <34 wk GA. Methods: A Hospital-based prospective study was conducted in tertiary care NICU.A total of 104 consecutive, eligible preterm babies <34 wk with echocardiographically documented PDA. Indomethacin (COX inhibitor) was administered orally in a dose of 0.2 mg/kg 12 h for 3 doses and the babies underwent Echo study in first 48 h, after2 days, 7days, and weekly thereafter till PDA closure. A second cycle of indomethacin was repeated if PDA did not respond to the initial treatment. Results: 75/104 (72%) PDAs closed with indomethacin while 13(12.5%) did not respond, and 16(15.38%) showed a reduction in the calibre of PDA. 26–30 wk group showed a brisk response to ductal closure with indomethacin within 108.1±12.44 h, and a mean no. of cycles of indomethacin of 0.98±5.75. Conclusion: With indomethacin we achieved 72% (75/104) closure rates. The best response to indomethacin was noted in 30–32 wk GA group, while maximum nonresponders were in 32–34 wk; suggesting as gestation increases, response to PG inhibitors decreases.

KEYWORDS: Patent ductusarteriosus, Cyclo-oxygenase, Indomethacin, Preterm Neonates, PG inhibitors, Ductus arteriosus, Ductal flow.


Full Text:

PDF

References


Lim MK, Hanretty K, Housten AB, Lilley S, Murtagh EP. Intermittent ductal patency in healthy new born infants demonstrated by colourdoppler flow mapping. Arch Dis Child 1992;67:1278.

Ellison RC, Peckham GJ, Lang P, Talner NS, Lerer TJ, Lin L, Dooley KJ, Nadas AS. Evaluation of the preterm infant of patent ductusarteriosus. Paediatric 1983;71:364–72.

Clyman RI, Couto J, Murphy GM. Patent ductusarteriosus: are current neonatal treatment options better or worse than no treatment at all? Semin Perinatol 2012;36(2):123–29.

Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR. Prevalence of spontaneous closure of the ductusarteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 2006;117(4):1113–

Nemerofsky SL, Parravicini E, Bateman D, Kleinman C, Polin RA, Lorenz JM. The ductusarteriosus rarely requires treatment in infants >1000 grams. Am J Perinatol 2008;25(10):661–66.

Reller MD, Rice MJ, McDonald RW. Review of studies evaluating ductal patency in the premature infant. J Pediatr 1993;122(6):S59–S62.

Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effects of indomethacin in premature infants with patient ductusarteriosus: results of a national collaborative study. J Pediatr 1983; 102(6): 895–906.

Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductusarteriosus in preterm infants. Cochrane Database Syst Rev 2003;(2): CD003745.

Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductusarteriosus in preterm and/ or low birth weight infants. Cochrane Database Syst Rev 2008:CD003481.

Malviya M, Ohlsson A, Shah S. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductusarteriosus in preterm infants. Cochrane Database Syst Rev 2008: CD003951.

Chock VY, Ramamoorthy C, Van Meurs KP. Cerebral autoregulation in neonates with a hemodynamically significant patent ductusarteriosus. J Pediatr 2012;160(6): 936–42.




Print ISSN: 2347-6192

Online ISSN: 2347-6206