INDOMETHACIN THERAPY ON THE FIRST DAY OF LIFE IN VERY-LOW-BIRTHWEIGHT INFANTS

Abstract

It has recently been suggested that early treatment with indomethacin(indo) of premature infants with asymptomatic heart murmurs decreased morbidity since the majority of these infants develop hemodynamically important shunts(SH) through a patent ductus arteriosus(PDA). Others suggest that treatment be given earlier as some infants have "silent" PDA. To investigate the optimal timing for treatment with indo, we performed a double-blind, controlled trial of indo therapy on the first day of life in 110 infants weighing 700-1300g at birth. Infants were treated with indo or placebo at a mean age of 14.8hrs. The incidence of SH in the placebo group was 20% (11/56) and 73% (11/15) of these infants who had asymptomatic murmurs developed SH. Indo therapy was associated with a decreased incidence of SH (2/54, p<.025) and a trend towards decreased surgical ligations (1/54 vs. 6/56, p<.1). There were no differences in incidence of complications including NEC and IVH. There were trends towards improvement in long-term outcome variables including decreased days in oxygen, decreased days of endotracheal intubation and decreased incidence of RLF in the indo group. We conclude that while treatment with indo on the first day of life prevented SH, there was no significant decrease in overall morbidity, perhaps because of the low incidence of SH in our study group. Another approach would be to treat infants with asymptomatic murmurs, as the majority of them will develop SH. However, treatment with indo on the first day of life did not increase complications and is safe to investigate in populations of very-low-birthweight infants with a higher incidence of hemodynamically important PDA shunts.