A preliminary report--heparin counteracts indomethacin effect on ductus arteriosus in very low birthweight infants.
OBJECTIVE
We report a clinical observation showing that continuous exposure to heparin via a central venous catheter is associated with patent ductus arteriosus treatment failure with indomethacin in very low birthweight infants.


METHODS
A clinical observational case report in infants weighting <1501 g.


METHODS
This study compares the rates of patent ductus arteriosus treatment failure during a) the index period from June 2, 2003, to August 22, 2003, when all very low birthweight infants with a peripherally inserted central venous catheter received continuous infusion of heparinized parenteral nutrition; b) the baseline period of 1 yr before the index period; and c) the postindex period of 1 yr after the index period.


RESULTS
The rate of patent ductus arteriosus treatment failure with indomethacin increased significantly during the index period compared with the baseline (odds ratio, 7.0; 95% confidence interval, 1.41-34.7; p = .017) and postindex periods (odds ratio, 33.8; 95% confidence interval, 4.72-243; p = .0005). The result was confirmed in logistic multivariable regression analysis.


CONCLUSIONS
This observation, based on a case series and their controls, serves as a basis for a new hypothesis suggesting that continuous exposure to heparin through heparinized central venous infusion significantly increases patent ductus arteriosus treatment failure with indomethacin. This hypothesis needs to be tested in a randomized controlled trial.
Ojala
Tiina H
TH
Department of Pediatrics, Turku University Central Hospital, Helsinki, Finland. tiina.h.ojala@hus.fi
Lehtonen
Liisa
L
D000925:Anticoagulants / Q000494:pharmacology*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002405:Catheterization, Central Venous; D004336:Drug Antagonism; D004373:Ductus Arteriosus / Q000187:drug effects*; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy*; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D017211:Treatment Failure
D000925:Anticoagulants; D002317:Cardiovascular Agents; D006493:Heparin; D007213:Indomethacin