1 Department of Pediatrics, Neonatal Unit, University Hospital of Leiden, Leiden, The Netherlands
In Reply.
We are very grateful for the commentary by Dr Rosenfeld on our article1 and share his concern about the possible adverse effects of indomethacin in sick and compromised preterm neonates.
We have some indication that the acute systemic effect of indomethacin (an increase in peripheral vascular resistance) also has an acute effect on ductal tissue. In most of the infants we observed, a negative diastolic flow velocity in the anterior cerebral artery existed before indomethacin treatment, suggesting a ductal steal phenomenon.