title: Fatal haemorrhagic gastritis associated with oral sulindac treatment for patent ductus arteriosus.
abstract: We report the first case in a preterm infant given oral sulindac for treatment of symptomatic patent ductus arteriosus who subsequently developed severe acute haemorrhagic gastritis leading to disseminated intravascular coagulation, massive pulmonary haemorrhage and death. The postmortem examination suggested that the mechanism was likely a direct irritant insult causing ischaemia on the gastric mucosa. Although sulindac is supposed to be a renal-sparing non-steroidal anti-inflammatory prodrug associated with minimal renal and gastrointestinal adverse effects, clinicians should be alerted to this potential life-threatening complication in preterm infants. Until the question of safety could be adequately addressed, the use of sulindac for ductal closure should remain experimental.
authors.affiliation: Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong.
authors.forename: P C
authors.initials: PC
authors.lastname: Ng
authors.forename: K W
authors.initials: KW
authors.lastname: So
authors.forename: T F
authors.initials: TF
authors.lastname: Fok
authors.forename: K F
authors.initials: KF
authors.lastname: To
authors.forename: W
authors.initials: W
authors.lastname: Wong
authors.forename: K
authors.initials: K
authors.lastname: Liu
mesh_terms: D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004200:Diseases in Twins; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy*; D017809:Fatal Outcome; D005756:Gastritis / Q000139:chemically induced*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007509:Irritants / Q000009:adverse effects*; D013467:Sulindac / Q000009:adverse effects*
chemical_list: D016861:Cyclooxygenase Inhibitors; D007509:Irritants; D013467:Sulindac