Echocardiographic flow pattern of patent ductus arteriosus: a guide to indomethacin treatment in premature infants
Bai-Horng Su, Ching-Tien Peng, Chang-Hai Tsai
Department of
Paediatrics China Medical College Hospital
2 Yuh Der Road Taichung
Taiwan
Correspondence to: Dr Bai-Horng Su.
Accepted 15 June
1999
AIM
To compare
the efficacy and safety of an indomethacin treatment strategy based on
serial echocardiographic measurement of patent ductus arteriosus (PDA)
flow pattern with a standard protocol.
METHODSNeonates
weighing less than 1500 g at birth, who required respiratory support,
and who had developed symptomatic PDA, were studied. PDA was confirmed
in all infants using colour Doppler echocardiography, and serial
observations of the ductal flow pattern were made. Infants randomly
assigned to receive conventional indomethacin treatment (protocol
group) were given an initial dose of 0.2 mg/kg, followed by 0.1 or 0.2 mg/kg, depending on age, 12 hourly for two further doses, and were
eligible for a second course. Those randomly assigned to the ductal
flow pattern assessment (ECHO group) received further doses of
indomethacin after 24 hours, only if their flow pattern was
"pulsatile" or "growing."
RESULTSThere
was no significant difference in the primary outcome measures between
the two groups. The closure rate was 89.1% and 87.2%, respectively,
in the protocol and ECHO groups. The mean (SD) doses of indomethacin
were significantly higher in the protocol group: 3.2 (1.4) doses
compared with 1.6 (0.9) doses. There was a significantly higher
incidence of hypoglycaemia, impaired urine output, and gastrointestinal
bleeding in the protocol group.
CONCLUSIONSAn
indomethacin treatment strategy for PDA based on measurement of the
ductal flow pattern is associated with a reduction in the total doses
of indomethacin administered, and a reduced rate of complications,
compared with a conventional protocol. There is no difference in
closure rate.
Keywords: echocardiographic measurement; PDA flow pattern; indomethacin; very low birthweight
© 1999 by Archives of Disease in Childhood
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