Indomethacin Prophylaxis for Patent Ductus Arteriosus (PDA) in Infants with a Birth Weight of Less Than 1250 Grams
SARAYUT SUPAPANNACHART, M.D.*, BENJAWAN PATCHAKAPATI,M.D.* PONGSAK KHOWSATHIT, M.D.*,
Affiliation : * Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Background : Very low birth weight (VLBW, less than 1500 g) and extremely low birth
weight infants (ELBW, less than 1000 g) are the premature infants that are most likely to develop
symptomatic PDA. Intravenous indomethacin has proven effective in prevention of PDA in many
prospective trials. This strategy will be a useful adjunctive therapy for premature infants in
Thailand.
Objective : To answer the following questions:
1. Will multiple doses of intravenous indomethacin, given to VLBW infants within the
first day of life, effectively prevent the occurrence of symptomatic PDA? Are there any side
effects or complications?
2. Will this strategy be more beneficial in ELBW?
Methods and
Subjects : The study included thirty VLBW infants born at Ramathibodi
Hospital, with birth weights ranging from 630 to 1230 g. They were randomized into 2 groups of
15 infants each. One group received 3 doses of intravenous indomethacin at the dosage of 0.2
mg/kg initially and then 0.1 mg/kg every 12 hours for 2 more doses; the second group received a
placebo. The study was performed by a double blind control.
Results : Sixteen infants developed symptomatic PDA, 4 in the indomethacin group and
12 in the placebo group. The decrease in incidence of PDA is statistically significant. But when
the data was analyzed separately for the VLBW and ELBW groups. The effects were only
significantly different in ELBW but not yet significant in the VLBW group. There was a sta-
tistically significant difference in the incidence of severe intraventricular hemorrhage (IVH)
(grade 3 or higher) in the ELBW infants.
Conclusion : Intravenous indomethacin therapy given to VLBW infants with a birth
weight of less than 1250 g decreased incidence of symptomatic PDA with no significant per-
manent side effects. The effect was markedly noticable in ELBW infants. Incidence of severe
IVH was also markedly decreased in the ELBW infants who received indomethacin.
Keywords : PDA, Indomethacin Prophylaxis, Premature Infant
