Abstract
Indomethacin is the mainstay in the management of patent ductus arteriosus (PDA) in neonates. Surfactant administration is associated with delay in PDA closure. The effectiveness of indomethacin in the closure of PDA in the post surfactant era is not well studied.
The objective was to assess the effectiveness of indomethacin for PDA closure in VLBW neonates who received surfactant.
Retrospective chart review of 103 VLBW neonates admitted between Nov. 2001 – Oct. 2003 was conducted. All infants received surfactant and were treated with indomethacin for PDA. The neonate was considered to be a responder to indomethacin if there was no clinical evidence of PDA for 72 hours after completion of the course.
Mean (SD) GA was 26.4 (1.7) weeks, BW was 886 (225) grams and Clinical Risk Index for Babies (CRIB) score was 4.9 (3.8). Antenatal steroids were given to 81 (79%) mothers. Twelve (12%) mothers had pregnancy induced hypertension, 7 (7%) had gestational diabetes, 4 (4%) received antenatal indomethacin, and 13 (13%) had chorioamnionitis. 56 neonates (54%) were born vaginally. Surfactant was given within 30 minutes in 70 (68%). 30 neonates (29%) received 0.1 mg/kg/dose and 73 (71%) received 0.2 mg/kg/dose of indomethacin (number of doses ranged from 1–5, median postnatal age when first dose given was 6, range 1–26). The response to indomethacin is shown in the figure. Oliguria was noted in 16 (16%), hyponatremia in 32 (31%), rise in creatinine in 9 (9%) and intestinal perforation in 2 (2%) neonates. Surfactant administration within 30 minutes (31% vs 13%; p=0.05), and higher CRIB score (6.4 vs 4.3; p=0.007) were associated with non-responsiveness to indomethacin.
Indomethacin is effective for PDA closure. A significant number of neonates required a second course. The response reduced with subsequent courses. Surfactant given early and severity of illness at admission were associated with non-responsiveness to indomethacin.
