Duration of indomethacin treatment of the preterm patent ductus arteriosus as directed by echocardiography.
OBJECTIVE
To determine whether the duration of indomethacin administration could be shortened in infants with good early constrictive response of patent ductus arteriosus (PDA).


METHODS
Infants born at< 30 weeks' gestational age were assessed with echocardiography in the first 12 hours of life and treated with indomethacin (0.1 mg/kg) if the PDA was >2 mm in diameter. Randomization occurred before the second dose to either standard treatment (2 more doses of indomethacin at 0.1 mg/kg irrespective of echocardiographic findings) or to echocardiographically directed duration of indomethacin treatment (ECHO; further doses only if the PDA was>1.6 mm). Serial echocardiography was performed to day 28 of age. The primary outcome was failure of PDA closure.


RESULTS
The infants were randomized to either the ECHO arm (n=34) or the standard treatment arm (n=40). No differences between the arms were seen in terms of failure of PDA closure, PDA reopening, need for further doses of indomethacin, or need for surgical ligation. More doses of indomethacin were given in the standard treatment arm (median, 3 doses [range, 1 to 12] vs 1 dose [range, 1 to 15]; P < .0001).


CONCLUSIONS
Echocardiographically directed duration of indomethacin treatment is effective in achieving PDA closure and offers the potential for dose minimization.
Carmo
Kathryn Browning
KB
Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia. kathryc4@chw.edu.au
Evans
Nick
N
Paradisis
Mary
M
D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D010865:Pilot Projects; D016896:Treatment Outcome
D016861:Cyclooxygenase Inhibitors; D007213:Indomethacin