Can dopamine prevent the renal side effects of indomethacin? A prospective randomized clinical study.
BACKGROUND
Indomethacin therapy for closure of a patent ductus arteriosus in preterm neonates is responsible for transient renal insufficiency. Dopamine theoretically reduces the renal side effects of indomethacin therapy.


METHODS
33 neonates with a mean gestational age of 28.5 weeks who received indomethacin for treatment of a symptomatic PDA were included in a prospective randomized controlled clinical study.


METHODS
15 patients were treated with indomethacin alone (control group), 18 patients with indomethacin and dopamine (study group). Indomethacin was given in a dose of 0.2 mg/kg/dose intravenously, all patients received three doses with intervall of 12 hours. The dose of dopamine was in all patients 4 micrograms/kg per minute commencing 2 hours prior to the first dose of indomethacin and continuing for 12 hours after the third dose.


RESULTS
Indomethacin induced a significant increase in serum creatinin (76.3 mumol/l vs 99.7 mumol/l for the control group, and 70.7 mumol/l vs 93.0 mumol/l for the study group), and weight (1259 g vs 1316 g for the control group, and 1187 g vs 1221 g for the study group). The increase systolic blood pressure (61 mmHg vs 65.7 mmHg) in the study group was significant (p < 0.05) but remained unchanged in the control group. The changes between the study group and the control group were not significant either in serum creatinin, fractional excretion of sodium, or weight gain. The failure rate of ductal closure was not different between the two groups.


CONCLUSIONS
The additional use of dopamine does not reduce the renal side effects of indomethacin.
Baenziger
O
O
Division of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Switzerland.
Waldvogel
K
K
Ghelfi
D
D
Arbenz
U
U
Fanconi
S
S
D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004298:Dopamine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004374:Ductus Arteriosus, Patent / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects* / Q000627:therapeutic use; D007231:Infant, Newborn; D008297:Male; D009318:Natriuresis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D015430:Weight Gain
D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D003404:Creatinine; D004298:Dopamine; D007213:Indomethacin