title: Change in blood pressure and pulse pressure in preterm infants after treatment of patent ductus arteriosus with indomethacin.
abstract: OBJECTIVE
  Patent ductus arteriosus (PDA) is associated with increased morbidity and mortality in premature infants. Therefore, an early diagnosis and treatment of a hemodynamically significant PDA are very important. A widened pulse pressure is considered to be a well known clinical sign of a PDA in older infants and children; however, whether this is also applicable in the case of preterm infants remains to be confirmed. The aims of this study were to investigate the change in blood pressure (BP) before and after medical treatment of a PDA with indomethacin and to evaluate if the change in the pulse pressure in preterm infants with a medically treated PDA could be used as a reliable clinical predictor of a hemodynamically significant PDA.
  
  
  METHODS
  Between January 2005 and June 2009, a retrospective analysis was performed in preterm infants with a hemodynamically significant PDA (PDA group, n=72) and preterm infants without a PDA (control group, n=72) at the Chonnam National University Hospital Neonatal Intensive Care Unit. The PDA was closed by treatment with indomethacin. The BP was compared between the two groups over the seven days after the first dose of indomethacin.
  
  
  RESULTS
  In preterm infants with a hemodynamically significant PDA, the mean systolic (55.1±6.0 mmHg) and diastolic BPs (31.4±6.2 mmHg) were lower than those in the controls (mean systolic BP 58.0±6.4 mmHg, mean diastolic BP 34.7±6.0 mmHg) before indomethacin treatment. When the ductus arteriosus was successfully closed by indomethacin treatment, there was a gradual increase in both the systolic and diastolic BPs without any change in the pulse pressure.
  
  
  CONCLUSIONS
  The results of this study show that a widened pulse pressure is not a useful clinical sign of a hemodynamically significant PDA in preterm infants. However, low systolic and diastolic BPs may be useful clinical signs of a hemodynamically significant PDA in preterm infants. If the systolic and diastolic BP is low, a PDA should be considered and echocardiography should be performed for early diagnosis and treatment.
authors: Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea.
authors: Ui Joung
authors: UJ
authors: Han
authors: Hwa Jin
authors: HJ
authors: Cho
authors: Young Kuk
authors: YK
authors: Cho
authors: Young Youn
authors: YY
authors: Choi
authors: Jae Sook
authors: JS
authors: Ma
references: Arch Dis Child Fetal Neonatal Ed. 1999 Nov;81(3):F168-70
references: 10525016
references: Arch Dis Child. 1993 May;68(5 Spec No):584-7
references: 8323360
references: J Pediatr. 1981 Feb;98(2):298-305
references: 7463231
references: Semin Neonatol. 2001 Feb;6(1):63-73
references: 11162286
references: Crit Care Med. 1990 May;18(5):490-3
references: 2328592
references: J Pediatr. 2007 Dec;151(6):624-8
references: 18035142
references: Am J Perinatol. 2004 Jul;21(5):257-61
references: 15232757
references: J Pediatr. 2000 Jul;137(1):68-72
references: 10891824
references: J Pediatr. 1981 Nov;99(5):767-71
references: 6795324
references: Semin Neonatol. 2003 Dec;8(6):425-32
references: 15001114
references: Arch Pediatr Adolesc Med. 1995 Oct;149(10):1136-41
references: 7550818
references: Crit Care Med. 1985 Jun;13(6):497-500
references: 3996003
references: Arch Dis Child. 1992 Oct;67(10 Spec No):1169-73
references: 1444551
references: Semin Neonatol. 2001 Feb;6(1):49-61
references: 11162285
references: J Pediatr. 1994 Aug;125(2):270-7
references: 8040777
references: Pediatrics. 1996 Mar;97(3):336-42
references: 8604266
references: Am Heart J. 1964 Oct;68:447-58
references: 14212725