Indomethacin decreases cerebral and mesenteric blood flow velocities (BFV) in premature infants with symptomatic patient ductus arteriosus (sPDA). plndo has been shown to be effective in preventing intraventricular hemorrhage (IVH) in VLBW infants. We investigated the effect of plndo on regional hemodynamics in 17 infants (775 to 1245g, 24 to 31 weeks gestation) who did not have sPDA. Middle cerebral (C) and superior mesenteric (M) artery Doppler BFVs and cardiac function were measured before and after each 0.1 mg/kg dose at 6, 30 and 54 hrs of life. Mean CBFV and MBFV decreased (ANOVA, p < 0.05) after plndo (Fig., M ± SE). Both C and M relative vascular resistance (RVR) increased (ANOVA, p < 0.05) after plndo, but the 40% change in C was significantly greater than the 20% change in M RVR (ANOVA, p < 0.05). In 3 infants who were fed after the 3rd plndo dose, the preprandial pre-plndo, preprandial post-plndo and postprandial post-plndo MBFV were 37.5 ± 1.5, 34 ± 3.1, and 46.7 ± 7.1 cm/sec, respectively. Cardiac output, stroke volume, fractional shortening, HR, BP, and SaO2 were not changed by plndo. We conclude that plndo 1) reduces CBFV and MBFV without affecting cardiac function and 2) increases cerebral RVR more than mesenteric. We speculate that this increase in cerebral RVR is a specific and beneficial effect which contributes to protection against IVH, whereas the smaller increase in mesenteric RVR does not impair normal post-prandial hyperemia in VLBW infants. (Supported by Wyeth Pediatrics).

figure 1

Figure 1