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Indomethacin therapy in premature infants with patent ductus arteriosus.

Journal of the Korean Pediatric Society 1991;34(10):1381-1390.
Published online October 31, 1991.
Indomethacin therapy in premature infants with patent ductus arteriosus.
Dug Ha Kim, Jung Hwan Choi, Chong Ku Yun
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
미숙아 동맥관 개존증에 대한 인도메타신 치료에 관한 연구
김덕하, 최중환, 윤종구
서울대학교 의과대학 소아과학교실
Received: 18 June 1991   • Accepted: 4 July 1991
Abstract
Patent ductus arteriosus (PDA) is a common disease that occurred in 20 〜 40 percent of premature infants. The incidence of PDA is inversely related to the gestational age and birth weight. Hemodynamically significant PDA increases the morbidity and mortality of premature infants. So, the management of PDA is one of the major problems in neonatal intensive care unit. Based on experimental animal studies, the use of indomethacin in an attempt to close the ductus arteriosus was introduced in 1976. Since then several studies have been reported the effect of in- domethacin on PDA of premature infant, but no study has been reported yet in Korea. The purpose of this study was to examine the response of PDA to indomethacin as well as to observe the complication of indomethacin. From August 1985 to July 1990, indomethacin was given to 18 premature infants for the phar- macological closure of symptomatic PDA in the neonatal intensive care unit (NICU) at Seoul National Unversity Children’s Hospital. Significant PDA was diagnosed on the basis of clinical and echocardiographic findings. The results obtained were as follows: 1) The PDA initially closed in 12 (6.7%) of 18 infants. But in one (8.3%) of 12 infants responsive to indomethacin, PDA reopened. Of 6 infants in whbm indomethacin therapy failed, 3 infants had surgical ligation, in 2 infants PDA closed spontaneously and after 2nd cycle of indomethacin therapy respectively. 2) 2 of 12 infants responsive to indomethacin therapy had maintenance indomethacin therapy for prevention of reopeii and PDA kept closed. 3) Closure rates were not significantly related to gestational age, birth weight, Apgar score, sex, presence of hyaline membrane disease but response was better in infants less than 7 days old than those more than 7 days old (83.3% vs 33.3%, p <0.05). 4) Oliguria occurred in 2 infants (11.1%) and hyponatremia occurred in one (5.6%), but they recoverd within 24 hours. Neither serum BUN, creatinine, sodium, nor potassium were altered significantly before and after indomethacin administration. Urine output fell 1 day after indometh- acin administration without statistical significance (64.7±20.6 ml/kg/day vs 57.0±17.4 ml/kg/day, p>0.05). We conclude that indomethacin has pharmacological effect on the closure of PDA in premature infants without any significant side effects.
Key Words: Indomethacin, Patent ductus arteriosus, Premature infants


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