Renal impairment associated with indomethacin treatment for patent ductus arteriosus in extremely preterm neonates--is postnatal age at start of treatment important?
OBJECTIVE
To study serum creatinine (SCr) levels following indomethacin for patent ductus arteriosus (PDA) closure in extremely preterm neonates in relation to postnatal age at the start of treatment.


METHODS
This was a retrospective (January 2000-December 2002) analysis of data on preterm neonates (gestation <29 weeks) who received indomethacin for PDA. Pre-existing renal malformation and/or impairment and high serum levels of nephrotoxic drugs were criteria for exclusion.


RESULTS
Indomethacin was commenced at postnatal age <7 days and >or=7 days in 60 (group 1) and 30 (group 2) neonates, respectively. The median (Q1, Q3) gestational age and birth weight for group 1 and group 2 neonates were 25 (23, 27) vs. 25 (24, 26) weeks and 740 (620, 909) vs. 780 (663, 966) grams, respectively. Postnatal age <7 days at start of indomethacin was associated with higher baseline (0.083 (0.074, 0.090) vs. 0.073 (0.054, 0.083) mmol/L, p=0.001) and peak SCr levels (0.099 (0.089,0.109) vs. 0.090 (0.064, 0.104) mmol/L, p=0.015). Logistic regression analysis controlling for gestational age and baseline SCr level indicated that postnatal age >or=7 days was a risk factor for elevated SCr after indomethacin (OR=13.4, 95% CI: 3.8-46.6, p < 0.001).


CONCLUSIONS
Postnatal age >or=7 days at the start of indomethacin is a predictor of a significant rise in SCr in extremely preterm neonates.
Srinivasjois
R M
RM
Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia.
Nathan
E A
EA
Doherty
D A
DA
Patole
S K
SK
D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects* / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D012189:Retrospective Studies; D014882:Water-Electrolyte Balance / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003404:Creatinine; D007213:Indomethacin