Necrotizing enterocolitis and gastrointestinal complications after indomethacin therapy and surgical ligation in premature infants with patent ductus arteriosus.
BACKGROUND
Indomethacin is the most frequently used pharmacological agent for closure of a patent ductus arteriosus (PDA) in premature infants. However, reports of complications, particularly, necrotizing enterocolitis (NEC) and isolated gastrointestinal perforation have generated concerns about the use of this medication.


OBJECTIVE
A retrospective study to compare the incidence of NEC, NEC-related gastrointestinal complications and isolated gastrointestinal perforation among premature infants treated for a PDA with either, indomethacin alone (I), surgical ligation alone (L), or indomethacin followed by surgical ligation (I-L).


METHODS
The medical records of 224 infants that underwent treatment, either pharmacological or surgical, for a PDA, confirmed by echocardiography, over a 4-year period (1995 to 1998) were analyzed. Treatment history and gastrointestinal complications were reviewed.


RESULTS
Of the 224 infants, 108 (48.2%) were treated with I, 50 (22.3%) by L, 66 (29.5%) with I-L. The clinical characteristics of the three treatment groups were similar and no differences in the incidence of NEC were observed between groups. NEC occurred in 14 (13%) of the I group, seven (14%) of the L group, and eight (12%) of the I-L group. The rate of NEC related gastrointestinal complications and isolated gastrointestinal perforation were also similar among groups.


CONCLUSIONS
In this large retrospective study, indomethacin treatment for a significant PDA in premature infants was not associated with a greater risk for NEC or NEC-related gastrointestinal complications than surgical ligation.
O'Donovan
Donough J
DJ
Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX 77030, USA.
Baetiong
Arlina
A
Adams
Karen
K
Chen
Ann
A
Smith
E O'Brian
EO
Adams
James M
JM
Weisman
Leonard E
LE
D001724:Birth Weight; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy* / Q000601:surgery*; D020345:Enterocolitis, Necrotizing / Q000209:etiology*; D005767:Gastrointestinal Diseases / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects* / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D007416:Intestinal Perforation / Q000209:etiology*; D008026:Ligation / Q000009:adverse effects; D012189:Retrospective Studies
D002317:Cardiovascular Agents; D007213:Indomethacin