Medical Management
Cyclo-oxygenase inhibitors like
1) INDOMETHACIN Indomethacin is a non-steroidal anti-inflammatory medication. It inhibits the production of prostaglandin. This tightens and constricts the PDA and finally closing it.
Premature babies with patent ductus arteriosus are at an increased risk for complications like IVH, intraventriuclar hemorrhage (bleeding in the brain). Researches have shown that when administered within 24 hours of birth, Indomethacin can close a PDA and can bring down the risk of IVH.
Dosage: In premature infants, about 0.1-0.2 mg/kg of Indomethacin is given about three times a day for three days. This can be repeated upto two more times.
Side effects: Important side effects of Indomethacin are
- Kidney dysfunction (with decreased urine production).
- Decreased platelet aggregation and making the infant prone to bleeding.
- Necrotizing Enterocolitis [NEC] – is a grave complication involving the bowel.
Contraindications:
- Bleeding disorder.
- Kidney dysfunction.
- Hyperbilirubinemia.
- Sepsis.
- Severe Congestive heart failure
- Organ failure.
Researches
Studies have shown that treating asymptomatic patients with PDA significantly decreases the occurrence of symptoms and the need for oxygen supplementation. Long-term effects were not known.
The final evidence of the efficacy of Indomethacin comes from Evidence Based Medical Research. A Cochrane study concluded stating Indomethacin is highly successful in closing the PDA, but upto 35% of the ductus re-opens. Some of the PDAs may not close after completing the allocated treatment. Prolongation of treatment did not have any significant benefits. Surgery is indicated for such patients.
2) IBUPROFEN
Studies have shown that by three days of starting Ibuprofen 60% of the PDAs have closed spontaneously.
Major adverse effect of Ibuprofen however is pulmonary hypertension. This pulmonary hypertension was responsive to nitric oxide therapy. Kidney dysfunction can cause a rise in Serum Creatinine level.
In some studies there were no statistical differences in the effectiveness of Ibuprofen and Indomethacin in the closure of patent ductus arteriosus. Chronic lung disease and pulmonary hypertension were seen in patients treated with ibuprofen. Incidence of oliguria was less.
A study performed in India in 2002 on a small group of infants and neonates concluded that oral Ibuprofen was safe and effective in premature babies with hemodynamically significant PDAs.
