T.F.YEH
Department of Pediatrics, College of Medicine,
National Cheng-Kung University, Tainan, Taiwan,
Chinese Taipei
Pre-maturity was frequently associated with persistent ductus arteriosus (PAD) and respiratory distress syndrome (RDS). The increased pulmonary flow caused by the PAD shunt was believed to exacerbate the pulmonary dysfunction caused by the RDS, and there was some evidence that pulmonary function could be improved by closing the PAD. Until recently, this could be done only surgically, but when is was discovered that inhibitors of prostaglandin synthesis promoted PDA closure, this led to the clinical use of such an inhibitor, indomethacin, to close the PDA pharmacologically.
Reports of this
use of indomethacin have been favorable, but not all cases were benefited, and
some trials have suggested that indomethacin might be less effective in
premature infants of very low gestational age,of very low birth weight, of higher
postnatal age and in those of higher postconceptional tract has been suggested
as a factor in at least some instances of poor response. Different
pharmacokinetics and different plasma concentration of indomethacin may also
contribute to various responses.
Although
indomethain may be effective in promoting PDA closure, its proper place in the
therapy of premature infants has not been well defined. Indomethacin can have
undesirable side effects, PDA in these babies can undergo spontaneous closure;
indomethacin administration was not always followed by PDA closure. In this
presentation, the therapeutic regimen of indomethacin, the indications, dosage,
side effect and its prevention will be discussed. The recent use of Ibuprofen
for ductus closure will also be discussed.