cardiovascular-agents and Enterocolitis--Necrotizing

Topics: Cardiovascular Agents; Ductus Arteriosus, Patent; Echocardiography; Enterocolitis, Necrotizing; Humans; Indomethacin; Infant, Newborn; Ligation; Pediatrics; Treatment Outcome

To describe factors associated with failure of patent ductus arteriosus closure and development of gastrointestinal complications in subjects treated with indomethacin.. Infants

Topics: Cardiovascular Agents; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Female; Humans; Indomethacin; Infant, Low Birth Weight; Infant, Newborn; Intestinal Perforation; Logistic Models; Male; Multivariate Analysis; Predictive Value of Tests; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome

Patent ductus arteriosus (PDA), especially PDA with sepsis, has been reported as a risk factor for feed intolerance in preterm neonates. In this study, the start to full feeds interval was found to be longest in preterm neonates (

Topics: Age Factors; Analysis of Variance; Cardiovascular Agents; Ductus Arteriosus, Patent; Enteral Nutrition; Enterocolitis, Necrotizing; Female; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Male; Prognosis; Risk Factors; Sepsis

Patent ductus arteriosus is a risk factor for the development of necrotizing enterocolitis. The use of indomethacin to treat patent ductus arteriosus in preterm infants may either decrease the incidence of necrotizing enterocolitis by stabilizing or closing the ductus arteriosus or increase its incidence by a direct constricting effect on mesenteric blood vessels. The authors sought to evaluate the interrelationship between patent ductus arteriosus, treatment with indomethacin and the risk of necrotizing enterocolitis in very low birth weight infants.. The Israel National database includes prospectively collected data on 99% of all very low birth weight infants in Israel. The study population comprised 6146 infants of 24-34 weeks' gestation born between 1995 and 2000. The effect of patent ductus arteriosus on necrotizing enterocolitis was assessed using multiple regression analysis.. Necrotizing enterocolitis occurred in 5.5% (n = 343) of all infants, in 9.4% of infants with patent ductus arteriosus and in 8.9% of infants who received indomethacin. The occurrence of necrotizing enterocolitis was independently associated with the presence of patent ductus arteriosus among infants not treated with indomethacin (odds ratio, 1.85) and those who received indomethacin therapy (odds ratio, 1.53). Indomethacin therapy in absence of patent ductus arteriosus was not associated with an increased risk of necrotizing enterocolitis (odds ratio, 0.72).. Patent ductus arteriosus is an independent risk factor for the development of necrotizing enterocolitis in very low birth weight infants. Therapy with indomethacin did not have a significant effect on the risk for necrotizing enterocolitis.

Topics: Cardiovascular Agents; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Female; Humans; Indomethacin; Infant; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Odds Ratio; Prevalence; Regression Analysis; Risk Factors

The effectiveness of continuous indomethacin (INDO) infusion versus bolus infusions for closure of patent ductus arteriosus (PDA) was investigated. The study design was an open-label case series (continuous INDO) with historic controls matched for gestational age (bolus INDO). Ductal closure rates were determined in two groups: 16 preterm infants with PDA treated with continuous INDO infusion (CONTIN group) and 16 control patients, matched for gestational age, who received bolus INDO infusions (BOLUS group). The total dosage was the same for both groups. PDA closed in seven of 16 preterm infants in the CONTIN group and in 13 of 16 in the BOLUS group ( p = 0.033, Fisher's exact test). In infants < 1000 g it was two of eight in the CONTIN group and 10 of 10 in the BOLUS group ( p = 0.002). Continuous INDO infusion was more likely than bolus infusion to be associated with failure of ductal closure (odds ratio, 19; 95% CI, 1.5 to 247; p = 0.023). This indicates that continuous infusion of INDO may be less effective in closing PDA than bolus infusions, especially in extremely low birth weight infants.

Topics: Cardiovascular Agents; Case-Control Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Female; Gestational Age; Humans; Indomethacin; Infant, Newborn; Infant, Very Low Birth Weight; Infusions, Intravenous; Logistic Models; Male; Oliguria; Retrospective Studies; Treatment Outcome

Indomethacin is the most frequently used pharmacological agent for closure of a patent ductus arteriosus (PDA) in premature infants. However, reports of complications, particularly, necrotizing enterocolitis (NEC) and isolated gastrointestinal perforation have generated concerns about the use of this medication.. A retrospective study to compare the incidence of NEC, NEC-related gastrointestinal complications and isolated gastrointestinal perforation among premature infants treated for a PDA with either, indomethacin alone (I), surgical ligation alone (L), or indomethacin followed by surgical ligation (I-L).. The medical records of 224 infants that underwent treatment, either pharmacological or surgical, for a PDA, confirmed by echocardiography, over a 4-year period (1995 to 1998) were analyzed. Treatment history and gastrointestinal complications were reviewed.. Of the 224 infants, 108 (48.2%) were treated with I, 50 (22.3%) by L, 66 (29.5%) with I-L. The clinical characteristics of the three treatment groups were similar and no differences in the incidence of NEC were observed between groups. NEC occurred in 14 (13%) of the I group, seven (14%) of the L group, and eight (12%) of the I-L group. The rate of NEC related gastrointestinal complications and isolated gastrointestinal perforation were also similar among groups.. In this large retrospective study, indomethacin treatment for a significant PDA in premature infants was not associated with a greater risk for NEC or NEC-related gastrointestinal complications than surgical ligation.

Topics: Birth Weight; Cardiac Surgical Procedures; Cardiovascular Agents; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Gastrointestinal Diseases; Gestational Age; Humans; Indomethacin; Infant, Newborn; Infant, Premature; Intestinal Perforation; Ligation; Retrospective Studies