Affiliations: Department of Pediatrics and Communicable Diseases,
University of Michigan, Ann Arbor, MI, USA | College of Pharmacy, University of Michigan, Ann
Arbor, MI, USA
Note: [] Corresponding author: Mohammad A. Attar, M.D., F5790 Mott
Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0254, USA. Tel.: +1
734 763 4109; Fax: +1 734 763 2278; E-mail: mattar@umich.edu
Abstract: Introduction: Patent ductus arteriosus (PDA) and its treatment are
associated with multiple serious complications in very low birth weight (VLBW)
infants. Methods: We retrospectively evaluated the effect of prophylactic
PDA treatment with Indomethacin on markers of utilization of hospital resources
in a regional neonatal intensive care unit (NICU) between January 1, 2005 and
April 30, 2007, including a six month epoch when PDA prophylactic treatment
with indomethacin was used in the study site. Infants with gestational ages
less than 28 weeks who survived for more than two days were included in the
analysis. Results: Twenty infants received Indomethacin prophylactic
treatment (treatment group) and 59 received no prophylactic treatment (control
group). Infants in the treatment group had similar median gestational age; 26
weeks, but higher birth weights (mean ± SD); 964 ± 247 vs 838 ± 198
grams, p=0.043 compared to control infants. Prophylactically treated infants
needed rescue PDA pharmacologic treatment less frequently (20% vs 63%,
p=0.002) but had similar rates of surgical ligation (30% vs 29%)
compared to control infants. Prophylactically treated infants also had
significantly higher rates of intestinal perforation (25% vs 7%, p=
0.041) and abdominal surgeries (30% vs 8%, p=0.03) compared to control
infants. The two groups had similar, duration of support with mechanical
ventilation and similar duration of supplement with parenteral nutrition.
Treatment and control infants had similar rate of survival to discharge to
home, 17 (85%) vs 45 (76%). Surviving treated and control infants did not
differ statistically in total observed hospital length of stay (LOS in days,
mean ± SD); (96 ± 32 vs 89 ± 29; p=0.43) nor in the difference
between observed and predicted LOS (mean observed- predicted ± SD) (10
± 23 vs1 ± 23; p=0.14). Conclusions: Prophylactic PDA
treatment with Indomethacin did not decrease duration of mechanical ventilation
or TPN supplementation but was associated with more intestinal perforations and
abdominal surgeries. The unfavorable trend in LOS for the treatment group
implies that the independent effect of prophylactic PDA treatment on LOS needs
to be further explored.
Keywords: Intestinal perforation, indomethacin, length of stay, NEC, sepsis
