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Necrotizing Enterocolitis and Gastrointestinal Complications After Indomethacin Therapy and Surgical Ligation in Premature Infants With Patent Ductus Arteriosus

Abstract

BACKGROUND: 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.

OBJECTIVES: 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).

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

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Acknowledgements

We thank Beth Lodinger, BSN, Suzanne Hegemier, BSN, Marcy Holden, BSN, Joan Wood, RN, and Audra Smith, for their participation in this study.

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O'Donovan, D., Baetiong, A., Adams, K. et al. Necrotizing Enterocolitis and Gastrointestinal Complications After Indomethacin Therapy and Surgical Ligation in Premature Infants With Patent Ductus Arteriosus. J Perinatol 23, 286–290 (2003). https://doi.org/10.1038/sj.jp.7210911

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