Abstract 154
Introduction: Usual guidelines for ductus arteriosus closure require three doses of indomethacin (0.2, 0.1, 0.1 mg/kg/12h if ≤28 wk or 0.2mg/kg:dose every 12 h for 3 doses if ≥29wk). Ibuprofen has been proposed to decrease side effects targeted on the kidney; Renal toxicity is dose-related and observed primarily with initial doses. We run a study, based on echography control of ductal patency, in order to reduce initial and total doses of indomethacin and to decrease renal adverse effects.
Study design: Prospective open study of premature babies ≤32 weeks born in 1997 and rescue therapy for large ductus arteriosus.
patients and methods: 26 patients in a cohort of 104 premature less than 32 weeks mean 28,4±1.6wk (26-31), 1080±340G(525-1800) required indomethacin for a large ductus arteriosus. Size of the ductus was Color Doppler as the "pulmonary" inner ductal diameter. A ductus was significant for a diameter larger than 1.5 mm. When prescribed at day 1, indomethacin dose was 0.1 mg/kg and after day 1, initial dose was 0.2 mg/kg infused intravenously over 20 min. Indomethacin was stopped when the echographic control showed a closed ductus. Diuresis, creatinine and kaliemia were measured to define kidney function. Renal side effects were defined as oliguria less than 2 ml/kg/h and creatinine level > 90µmol/l after day 2.
results: The mean ductal diameter in our population was 2.7±0.7mm(2-4.5). The mean total dose infused was 0,26 mg/kg±0.15. 11 pts(42%) received only one (mean dose 0.13mg) and 7(26%) closed their ductus with only 0.1 mg/kg. For the others, 4 required two doses7 three doses and only 3 children were treated more than 3 days. In average, the first dose was given at day 3(0-10) and for 10 pts (38%) before day 1. Successful rate of closure was 25/26 (96%). 1/26 reopening closed after a second treatment. Only one small ductus, left opened, spontaneously closed after 6 months. 9/26 (23%) showed transient oliguria less than 24 hours and 6/26 (23%) had transient renal failure according to oliguria and creatinine >90µmol/l.
conclusion: Indomethacin ductus arteriosus closure controlled by echography between each dose reduced the average total dose. A low dose (0.1 mg/kg) is able to close a ductus. The certitude of the ductal closure prevents &guillemotleft; reopening &guillemotright;. Less renal side effects in larger population are expecting in this strategy.
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Morville, P., Bednarek, N. Ductus Arteriosus Closure Controlled by Echography Reduced Indomethacin Total Doses. Consequences on Renal Side Effects. Pediatr Res 45, 28 (1999). https://doi.org/10.1203/00006450-199904020-00170
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DOI: https://doi.org/10.1203/00006450-199904020-00170