Prophylactic Indomethacin Revisited

Persistent patency of the ductus arteriosus (PDA) has challenged neonatologists for more than 40 years. 1 , 2 Surgical ligation of the ductus was first performed in children nearly 80 years ago 3 and proved that prevention of prolonged exposure to left-to-right shunting through the ductus arteriosus...

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Bibliographic Details
Published in:The Journal of pediatrics 2017-07, Vol.186, p.11-14.e1
Main Authors: Reese, Jeff, MD, Shelton, Elaine L., PhD, Slaughter, James C., PhD, McNamara, Patrick J., MD
Format: Article
Language:English
Subjects:
Bronchopulmonary Dysplasia
ductus arteriosus
Humans
Indomethacin
Infant
Infant, Extremely Premature
Infant, Newborn
Pediatrics
prophylaxis
Risk
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Summary:Persistent patency of the ductus arteriosus (PDA) has challenged neonatologists for more than 40 years. 1 , 2 Surgical ligation of the ductus was first performed in children nearly 80 years ago 3 and proved that prevention of prolonged exposure to left-to-right shunting through the ductus arteriosus improved pulmonary, cardiac, and systemic outcomes. In the 1970s, the discovery that nonsteroidal anti-inflammatory drugs could induce PDA closure 4 – 7 and are effective in infants born preterm 8 , 9 provided neonatologists with a pharmacologic alternative to surgery. The clear advantages, however, of having a medical approach have been clouded by conflicting information on the long-term benefits of treatment, disagreement regarding the clinical indicators that warrant treatment for PDA, optimal drug choice, preferred dosing regimens, and indecision regarding the best time to treat a select population of fragile preterm infants.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2017.03.036