Pharmacologic Closure of Patent Ductus Arteriosus in the Premature Infant

TLDR

Prostaglandins regulate ductus arteriosus tone, and a patent ductus often worsens the clinical course of premature infants with respiratory‑distress syndrome. The study aimed to evaluate whether a single oral or rectal dose of indomethacin could pharmacologically close the patent ductus arteriosus in premature infants who would otherwise require surgical ligation. Indomethacin, a potent prostaglandin‑synthesis inhibitor, was given orally or rectally as a single dose to six consecutive premature infants. Within 24 hours all clinical, echocardiographic, and radiographic signs of left‑to‑right shunting resolved, with only transient renal dysfunction in two infants, demonstrating that pharmacologic closure of the ductus is achievable. Published in N Engl J Med 295:526–529, 1976.

Abstract

The prostaglandins affect smooth-muscle tone of the ductus arteriosus. Patent ductus often complicates the clinical course of prematurely born infants with respiratory-distress syndrome. In the present study, a single oral or rectal dose of a potent inhibitor of prostaglandin synthesis, indomethacin, was administered to six consecutive premature infants with the syndrome who would otherwise have undergone surgical ligation of the patent ductus. Within 24 hours all the clinical symptoms and physical, echocardiographic and radiographic signs attributable to substantial left-to-right shunting through a patent ductus arteriosus dramatically and permanently disappeared. A transient reduction in renal function was observed in two infants in whom sustained ill-effects did not occur. The observation that constriction and closure of the patent ductus arteriosus may be induced pharmacologically raises important possibilities for the improved treatment of the respiratory-distress syndrome. (N Engl J Med 295:526–529, 1976)