Abstract
Dept.of Neonatology,Univ.of Vienna,A-1090,Währinger G.74 It has been suggested,that failure of I induced PDA closure may be related to a low plasma concentration(PC)(1). Thus,it was claimed,that on-line I level monitoring is mandatory for any prolonged therapy(2).5 boys and 5girls, mean gestational age 32,3 wks. (28-34),mean birth weight 1430 gms(800-2220) were studied.All had RDS with pulmonary and circulatory congestive failure secondary to PDA. The diagnosis was based on clinical judgement and echo-cardiography(E).Treatment was initiated according to the following protocol:0,3 mg/kg of I i.v. 3 x q 12 hrs as loading dose,thereafter 2x o,15 mg/kg q 24 hrs as maintenance dose(2).I was determined by high pressure liquid chromatography.Furthermore,creatinin-,free water-,osmolar clearance and fractional sodium excretion were determined prior and twice during therapy.Therapy was effective in 9/10 patients.The overall peak I PC was 1,62±0,68 mcg/ml(M±SD) (Range:O,7-2,8):in 9/10 patients PC after loading dose exceeded 1,0 mcg/ml,maintenance levels were 0,5-1 mcg/ml in 6 patients, 1-2 mcg/ml in 4 patients.In all patients transitory impairment of renal functions occured,which recovered within 2 wks. No clear dose dependent PC of I was observed.PC of I showed a large scatter in the population studied,but was consistent within each individual.Routine drug monitoring of I for PDA treatment according to the protocol described is not mandatory.
(1)Brash,A.R.et al.: N.Engl.J.Med.305:67-72(1981)
(2)Seyberth,H.W.et al:Ped.Cardiol.4(Suppl.II)81-84(1983)
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Weninger, M., Pollak, A., Popow, C. et al. Prolonged Indomethac in (I) Therapy in Premature Newborns with Patent Ductus Arteriosus (PDA). Is Drug Monitoring Mandatory?. Pediatr Res 18, 800 (1984). https://doi.org/10.1203/00006450-198408000-00055
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DOI: https://doi.org/10.1203/00006450-198408000-00055