PEDIATRICS Vol. 64 No. 2 August 1979, pp. 154-159
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Indomethacin Therapy for Large Patent Ductus Arteriosus in the Very Low Birth Weight Infant: Results and Complications

H. L. Halliday MB, DCH, MRCP1, T. Hirata MD1, and J. P. Brady MB, BChir1

1 Children's Hospital of San Francisco and Cardiovascular Research Institute, University of California, San Francisco

Of 36 very low birth weight infants (<1,500 gm) with large patent ductus arteriosus, 24 (67%) showed satisfactory constriction or closure after indomethacin therapy (mean total dose 0.4 mg/kg). Twelve infants (33%) responded inadequately with seven infants requiring surgical ligation. Response was better in infants 8 to 14 days old compared to those more than 14 days old (89% vs 33%, P = .048) irrespective of birth weight or gestational age. Major complications were renal and unrelated to ductus response. Urine output fell significantly (3.65 to 1.63 ml/kg/hr, P < .001) and in 47% of infants serum creatinine increased ge1.5 mg/dl. Creatinine was less likely to rise in infants more than 14 days old. Hyponatremia was found in 36% of infants. Serum potassium increased more frequently in infants more than 8 days old and was >6.0 mEq/liter in 25%. Indomethacin caused a reduction in PaCO2 (41 to 37 mm Hg, P < .01) and an increase in pH (7.32 to 7.36, P < .02) with no change in base deficit. These changes occurred even in the absence of clinical ductus closure. No other side effects of indomethacin therapy were noted. Three infants died but death was unrelated to indomethacin therapy. Overall survival was 92%, and nine infants (25%) developed mild bronchopulmonary dysplasia.

Submitted on August 10, 1978
Accepted on December 18, 1978




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