Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 2, 1997

HK J Paediatr (New Series) 1997;2:180-181

Proceedings of Scientific Meeting

Indomethacin Regimes for Patent Ductus Arteriosus in Premature Newborn

KL Siu, KM Wan, CW Law, WH Lee

HK J Paediatr (new series) 1997;2:175-186

Hong Kong Paediatric Society 35th Anniversary Scientific Meeting September 6,1997

This is a retrospective review on the effectiveness and side effects of two indomethacin regimes for closure of patent ductus arteriosus in premature newborns. There were ninety-four premature newborns of birth weight between 500 - 1500 gin, born in or transferred to Queen Elizabeth Hospital from 1st Jan. to 31st Dec, 1994. They were divided into two groups on an alternate day basis according to their dates of birth. Of these ninety-four newborn, there were altogether 37 PDA-newborn, with 20 in Group I and 17 in Group 2. PDA was confirmed by presence of the typical murmur and by 2-D Echocardiogram in 85% and 88% in Group I and Group 2 respectively. All PDA-newborn with persistent heart murmur and ventilator dependency were treated with indomethacin . Group I babies received intravenous indomethacin 0.2 mg/Kg/dose for 3 doses every 12 hours then 3 further doses every 24 hours intravenously cumulative dose = 1.2 mg/Kg ), while Group 2 babies received 0.1 mg/Kg/dose for 6 doses every 24 hours intravenously ( cumulative dose = 0.6 mg/ Kg). Ductal closure was defined as persistent disappearance of the heart murmur with or without Echocardiogram confirmation; and relapse as persistent reappearance of heart murmur. Non-responders to first course of indomethacin will be given a second course; those in whom the second course was contraindicated or failed were subjected to surgical ligation. Side effects related to indomethacin treatment were recorded.

Group I and Group 2 newborns had comparable mean gestation ( 28 6/7 weeks vs 27 6/7 weeks ) and birth weight (1087 gm vs 1104 gm). 19 out of 20 in Group I and 9 out of 17 in Group 2 were given indomethacin. Mean age of starting indomethacin was Day 8.5 in Group I, and Day 5.6 in Group 2. One baby in Group 1 and two in Group 2 needed a second course.

The overall incidence of PDA was 39.4 % . Ductal closure rate after first course of indomethacin ( ductal closure by indomethacin / no. given indomethacin) was similar for both groups ( Group 1; 84.2% vs Group 2: 78% ); and the overall ductal closure rate (PDA closure without indomethacin + ductal closure after first course indomethacin / total PDA-newborn) were 85% and 76.5% respectively. One in Group 1 and two in Group 2 required surgical ligation because of failed indomethacin treatment.

The common side effects were thrombocytopenia (10.5 % in Group I and 22 % in Group 2) and raised serum creatinine ( 31.5 % in Group I and 11 % in Group 2 ); both were mild and transient. Suspected necrotizing enterocolitis presenting with abdominal distension was seen in 4 out of 19 Group I newborns (21%) and none in Group 2. Severe neonatal jaundice or progression of periventricular haemorrhage was not encountered.

Conclusion: Both regimes were effective in ductal closure and the results were comparable to that of the National Collaborative Study ( 79%: Gersony -1983 ). Side effects encountered in either regimes were mild and transient.


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