Original ArticlesEarly versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome☆
Section snippets
Subjects
Neonates admitted to 4 neonatal intensive care units were eligible for enrollment if they met the following inclusion criteria: (1) gestational age <32 weeks, (2) respiratory distress syndrome for which ventilatory support was needed by means of mechanical ventilation (either conventional or prophylactic high-frequency oscillatory ventilation) or continuous positive airway pressure with additional oxygen requirements above 30% fraction of inspired oxygen, (3) age of 3 days, and (4)
Study population
Of the 380 preterm infants with respiratory distress syndrome who were eligible for entry into the study, 127 (33%) had moderate to severe PDA shunting and were randomly assigned to treatment groups (Table I).At the start of the study, echocardiographic evaluations were comparable between early and late treatment groups: ductal diameter (2.5 ± 0.7 mm vs 2.3 ± 0.8 mm; mean ± SD), ductal maximal left-to-right shunt velocity (1.50 ± 0.49 m/s vs 1.52 ± 0.48 m/s), and number of infants with moderate
Discussion
We found that when indomethacin treatment was postponed until the end of the first week of life in infants with PDA confirmed by echocardiography, there was a spontaneous PDA closure in 43% (27/63) of them and a diminution of the ductal left-to-right shunt, alleviating the need for further treatment in another 16% (10/63). Although significantly more infants had a PDA on days 6 and 9 in this late treatment group, the final closure rate and the need for surgical ligation were comparable with
Acknowledgements
We thank the nurses and the staff of the neonatal units for collecting the urine samples and all the clinical data used in this report.
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Cited by (0)
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Reprint requests: Bart Van Overmeire, MD, PhD, Department of Pediatrics, Division of Neonatology, University Hospital Antwerpen, Wilrijkstraat 10, B-2650 Edegem, Belgium.