From the FDA Drug Label
Indomethacin is indicated for the closure of a patent ductus arteriosus (PDA) in premature infants. The medication indicated for a 2-day-old infant with a suspected patent ductus arteriosus (PDA) presenting with a rough, machinery-like murmur best heard at the left second intercostal space is indomethacin (IV) 1.
- Key points:
- Indomethacin is used to treat PDA in premature infants.
- The medication works by inhibiting prostaglandin synthesis, which helps to close the ductus arteriosus.
- The dosage and administration of indomethacin should be carefully monitored in pediatric patients, especially in those with suspected PDA.
From the Research
Indomethacin is the primary medication indicated for a 2-day-old infant with a suspected patent ductus arteriosus (PDA) presenting with a rough, machinery-like murmur at the left second intercostal space. The typical dosing regimen consists of three intravenous doses: 0.2 mg/kg for the first dose, followed by 0.1 mg/kg for the second and third doses, administered at 12-24 hour intervals. Alternatively, ibuprofen can be used at a dose of 10 mg/kg for the first dose, followed by 5 mg/kg for the second and third doses, given 24 hours apart. Before initiating treatment, renal function, platelet count, and bleeding parameters should be assessed, as these medications can affect kidney function and platelet aggregation. These medications work by inhibiting prostaglandin synthesis, which promotes closure of the ductus arteriosus. The ductus arteriosus normally closes spontaneously within the first few days of life, but when it remains patent, it can lead to increased pulmonary blood flow and potential heart failure. Early treatment is important to prevent complications such as pulmonary hypertension, heart failure, and poor growth. Echocardiography should be performed to confirm the diagnosis before starting medication, as seen in studies such as 2. However, a more recent study 3 suggests that paracetamol could be considered as a promising and safe therapy for the treatment of PDA in preterm infants, with a success rate of 90.9% in achieving ductal closure. But based on the highest quality and most recent study available 4, ibuprofen is as efficacious as indomethacin for the treatment of patent ductus arteriosus in preterm infants and is significantly less likely to induce oliguria, making it a viable alternative to indomethacin. It's also worth noting that another study 5 found no significant difference in digestive and renal complications between indomethacin and ibuprofen, but the study 4 provides more robust evidence for the comparison between the two medications. In clinical practice, the choice between indomethacin and ibuprofen should be based on individual patient factors and the potential risks and benefits of each medication, as well as the presence of any contraindications. Overall, the decision to use indomethacin or ibuprofen should be made on a case-by-case basis, taking into account the latest evidence and the specific needs of the patient.