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. 1986 Mar;61(3):233–238. doi: 10.1136/adc.61.3.233

Early administration of indomethacin to preterm infants.

J M Rennie, J Doyle, R W Cooke
PMCID: PMC1777724  PMID: 3516077

Abstract

Indomethacin (0.2 mg/kg) or saline was given intravenously during the first 24 hours to 50 preterm infants in a double blind controlled trial. Eight of the control group later required treatment with indomethacin for clinical signs of left to right shunt, but only one in the treatment group (p = 0.03). Treatment with indomethacin prolonged bleeding time, raised serum creatinine concentrations, and was associated with gastrointestinal haemorrhage in seven infants. Five of these had a serum indomethacin concentration greater than 1.0 microgram/ml. There was a significant reduction of the stable metabolite of prostacyclin, 6-ketoprostaglandin F1 alpha, commencing six hours after treatment and lasting for four days. There was no significant difference in the incidence of intraventricular haemorrhage, days of treatment with oxygen or ventilation, or mortality between the two groups.

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Selected References

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  1. Brash A. R., Hickey D. E., Graham T. P., Stahlman M. T., Oates J. A., Cotton R. B. Pharmacokinetics of indomethacin in the neonate. Relation of plasma indomethacin levels to response of the ductus arteriosus. N Engl J Med. 1981 Jul 9;305(2):67–72. doi: 10.1056/NEJM198107093050203. [DOI] [PubMed] [Google Scholar]
  2. Clyman R. I., Mauray F., Roman C., Rudolph A. M. PGE2 is a more potent vasodilator of the lamb ductus arteriosus than is either PGI2 or 6 keto PGF1alpha. Prostaglandins. 1978 Aug;16(2):259–264. doi: 10.1016/0090-6980(78)90028-x. [DOI] [PubMed] [Google Scholar]
  3. Coceani F., Olley P. M., Lock J. E. Prostaglandins, ductus arteriosus, pulmonary circulation: current concepts and clinical potential. Eur J Clin Pharmacol. 1980 Jul;18(1):75–81. doi: 10.1007/BF00561482. [DOI] [PubMed] [Google Scholar]
  4. Cockbill S. R., Heptinstall S., Taylor P. M. A comparison of the abilities of acetylsalicylic acid, flurbiprofen and indomethacin to inhibit the release reaction and prostaglandin synthesis in human blood platelets. Br J Pharmacol. 1979 Sep;67(1):73–78. [PMC free article] [PubMed] [Google Scholar]
  5. Corazza M. S., Davis R. F., Merritt T. A., Bejar R., Cvetnic W. Prolonged bleeding time in preterm infants receiving indomethacin for patent ductus arteriosus. J Pediatr. 1984 Aug;105(2):292–296. doi: 10.1016/s0022-3476(84)80135-3. [DOI] [PubMed] [Google Scholar]
  6. Friedman W. F., Hirschklau M. J., Printz M. P., Pitlick P. T., Kirkpatrick S. E. Pharmacologic closure of patent ductus arteriosus in the premature infant. N Engl J Med. 1976 Sep 2;295(10):526–529. doi: 10.1056/NEJM197609022951003. [DOI] [PubMed] [Google Scholar]
  7. Heymann M. A., Rudolph A. M., Silverman N. H. Closure of the ductus arteriosus in premature infants by inhibition of prostaglandin synthesis. N Engl J Med. 1976 Sep 2;295(10):530–533. doi: 10.1056/NEJM197609022951004. [DOI] [PubMed] [Google Scholar]
  8. Horton R., Zipser R., Fichman M. Prostaglandins, renal function and vascular regulation. Med Clin North Am. 1981 Jul;65(4):891–914. doi: 10.1016/s0025-7125(16)31504-8. [DOI] [PubMed] [Google Scholar]
  9. Kocsis J. J., Hernandovich J., Silver M. J., Smith J. B., Ingerman C. Duration of inhibition of platelet prostaglandin formation and aggregation by ingested aspirin or indomethacin. Prostaglandins. 1973 Feb;3(2):141–144. doi: 10.1016/0090-6980(73)90081-6. [DOI] [PubMed] [Google Scholar]
  10. Käpä P., Lanning P., Koivisto M. Early closure of patent ductus arteriosus with indomethacin in preterm infants with idiopathic respiratory distress syndrome. Acta Paediatr Scand. 1983 Mar;72(2):179–184. doi: 10.1111/j.1651-2227.1983.tb09693.x. [DOI] [PubMed] [Google Scholar]
  11. Lucas A., Mitchell M. D. Plasma-prostaglandins in pre-term neonates before and after treatment for patient ductus arteriosus. Lancet. 1978 Jul 15;2(8081):130–132. doi: 10.1016/s0140-6736(78)91510-6. [DOI] [PubMed] [Google Scholar]
  12. Maher P., Lane B., Ballard R., Piecuch R., Clyman R. I. Does indomethacin cause extension of intracranial hemorrhages: a preliminary study. Pediatrics. 1985 Mar;75(3):497–500. [PubMed] [Google Scholar]
  13. Mahony L., Caldwell R. L., Girod D. A., Hurwitz R. A., Jansen R. D., Lemons J. A., Schreiner R. L. Indomethacin therapy on the first day of life in infants with very low birth weight. J Pediatr. 1985 May;106(5):801–805. doi: 10.1016/s0022-3476(85)80361-9. [DOI] [PubMed] [Google Scholar]
  14. Mahony L., Carnero V., Brett C., Heymann M. A., Clyman R. I. Prophylactic indomethacin therapy for patent ductus arteriosus in very-low-birth-weight infants. N Engl J Med. 1982 Mar 4;306(9):506–510. doi: 10.1056/NEJM198203043060903. [DOI] [PubMed] [Google Scholar]
  15. Mehta A. C., Calvert R. T. An improved high-performance liquid chromatographic procedure for monitoring indomethacin in neonates. Ther Drug Monit. 1983;5(1):143–145. doi: 10.1097/00007691-198303000-00018. [DOI] [PubMed] [Google Scholar]
  16. Mellander M., Leheup B., Lindstrom D. P., Palme C., Graham T. P., Jr, Stahlman M. T., Cotton R. B. Recurrence of symptomatic patent ductus arteriosus in extremely premature infants, treated with indomethacin. J Pediatr. 1984 Jul;105(1):138–143. doi: 10.1016/s0022-3476(84)80380-7. [DOI] [PubMed] [Google Scholar]
  17. Metz S. A. Anti-inflammatory agents as inhibitors of prostaglandin synthesis in man. Med Clin North Am. 1981 Jul;65(4):713–757. doi: 10.1016/s0025-7125(16)31495-x. [DOI] [PubMed] [Google Scholar]
  18. Pace-Asciak C. R., Rangaraj G. The 6-ketoprostaglandin F1alpha pathway in the lamb ductus arteriousus. Biochim Biophys Acta. 1977 Mar 25;486(3):583–585. doi: 10.1016/0005-2760(77)90113-8. [DOI] [PubMed] [Google Scholar]
  19. Pickard J. D. Role of prostaglandins and arachidonic acid derivatives in the coupling of cerebral blood flow to cerebral metabolism. J Cereb Blood Flow Metab. 1981;1(4):361–384. doi: 10.1038/jcbfm.1981.41. [DOI] [PubMed] [Google Scholar]
  20. Rane A., Oelz O., Frolich J. C., Seyberth H. W., Sweetman B. J., Watson J. T., Wilkinson G. R., Oates J. A. Relation between plasma concentration of indomethacin and its effect on prostaglandin synthesis and platelet aggregation in man. Clin Pharmacol Ther. 1978 Jun;23(6):658–668. doi: 10.1002/cpt1978236658. [DOI] [PubMed] [Google Scholar]
  21. Rennie J. M., Gibson T., Cooke R. W. Micromethod for bleeding time in the newborn. Arch Dis Child. 1985 Jan;60(1):51–53. doi: 10.1136/adc.60.1.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rosenkranz B., Kitajima W., Frölich J. C. Relevance of urinary 6-keto-prostaglandin F1 alpha determination. Kidney Int. 1981 Jun;19(6):755–759. doi: 10.1038/ki.1981.77. [DOI] [PubMed] [Google Scholar]
  23. Rudd P., Montanez P., Hallidie-Smith K., Silverman M. Indomethacin treatment for patent ductus arteriosus in very low birthweight infants: double blind trial. Arch Dis Child. 1983 Apr;58(4):267–270. doi: 10.1136/adc.58.4.267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Seyberth H. W., Müller H., Ulmer H. E., Wille L. Urinary excretion rates of 6-keto-PGF1 alpha in preterm infants recovering from respiratory distress with and without patent ductus arteriosus. Pediatr Res. 1984 Jun;18(6):520–524. doi: 10.1203/00006450-198406000-00007. [DOI] [PubMed] [Google Scholar]
  25. Seyberth H. W., Müller H., Wille L., Plückthun H., Wolf D., Ulmer H. E. Recovery of prostaglandin production associated with reopening of the ductus arteriosus after indomethacin treatment in preterm infants with respiratory distress syndrome. Pediatr Pharmacol (New York) 1982;2(2):127–141. [PubMed] [Google Scholar]
  26. Skidgel R. A., Friedman W. F., Printz M. P. Prostaglandin biosynthetic activities of isolated fetal lamb ductus arteriosus, other blood vessels, and lung tissue. Pediatr Res. 1984 Jan;18(1):12–18. [PubMed] [Google Scholar]
  27. Yanagi R. M., Wilson A., Newfeld E. A., Aziz K. U., Hunt C. E. Indomethacin treatment for symptomatic patent ductus arteriosus: a double-blind control study. Pediatrics. 1981 May;67(5):647–652. [PubMed] [Google Scholar]

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