High Dose Indomethacin for Patent Ductus Arteriosus Closure Increases Neonatal Morbidity.

Waldvogel, Salome; Atkinson, Andrew; Wilbeaux, Mélanie; Nelle, Mathias; Berger, Markus Rudolf; Gerull, Roland (2021). High Dose Indomethacin for Patent Ductus Arteriosus Closure Increases Neonatal Morbidity. American journal of perinatology, 38(7), pp. 707-713. Thieme Medical Publishers 10.1055/s-0039-3400996

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OBJECTIVE

Symptomatic patent ductus arteriosus (sPDA) is the most common heart abnormality in preterm infants. Optimal duration and dose of medical treatment is still unclear. We assessed undesired effects and closure rate of high-dose indomethacin (HDI) for pharmacological closure of sPDA.

STUDY DESIGN

Retrospective single center analysis of 248 preterm infants born between January 2006 and December 2015 with a birth weight <2,000 g and sPDA which was treated with indomethacin. Patients were treated with either standard dose indomethacin (SDI; n = 196) or HDI (n = 52). Undesired effects and PDA closure were compared between patients treated with SDI and HDI.

RESULTS

In univariate analysis, patients receiving HDI had a significant increase in gastrointestinal hemorrhage (32.7 vs.11.7%, p = 0.001), bronchopulmonary dysplasia (BPD) (77.8 vs. 55.1%, p = 0.003), and retinopathy of prematurity (13.5 vs. 2.6%, p = 0.004). Moreover, HDI patients needed longer mechanical ventilation (2.5 vs. 1.0 days, p = 0.01). Multivariate analyses indicated that necrotizing enterocolitis (17 vs. 7%, p = 0.01) and BPD (79 vs. 55%, p = 0.02) were more frequent in HDI patients. PDA closure rate was 79.0% with HDI versus 65.3% with SDI.

CONCLUSION

HDI used for PDA closure is associated with an increase in necrotizing enterocolitis and BPD. Risks of HDI should be balanced against other treatment options.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Atkinson, Andrew; Nelle, Mathias; Berger, Markus Rudolf and Gerull, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0735-1631

Publisher:

Thieme Medical Publishers

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

11 Dec 2020 11:00

Last Modified:

30 May 2021 01:31

Publisher DOI:

10.1055/s-0039-3400996

PubMed ID:

31887749

BORIS DOI:

10.7892/boris.148179

URI:

https://boris.unibe.ch/id/eprint/148179

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