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 ≥1.5 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.
- Received August 10, 1978.
- Accepted December 18, 1978.
- Copyright © 1979 by the American Academy of Pediatrics