Patent ductus arteriosus (PDA)
Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth, resulting in a left-to-right shunt. Symptoms may include failure to thrive, poor feeding, tachycardia, and tachypnea. A continuous machine-like murmur in the upper left sternal border is common. Diagnosis is by echocardiography. Administration of indomethacin with or without fluid restriction may be tried in premature infants with a significant shunt but not in term infants with PDA. If the connection persists, surgical or catheter-based correction is indicated. Endocarditis prophylaxis is recommended before and for 6 to 12 mo after correction.
can we used indomethacine in the child after 5 months with patent ductus arteriosus ?
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Filed Under: Discussion • pediatrics
I think indomethacine is only effective in closing a patent ductus arteriosus if it is administered in the first 10-14 days of life ,so it is no used after 5 month of life .
Indomethacin has proved since long to be effective in the closure of PDA. Various studies have demonstrated that the success of closure diminishes markedly with increasing postnatal age. We find in neonatal textbooks, that indomethacin is effective in the first 10-14 days of life(as stated by admin).
Furthermore, it is suggested that surgical ligation be performed after the first month of life due to the fact that the effect of indomethacin decreases with increasing postnatal age(v.s).
We will surely agree that medicinal closure in premature infants no longer works more than 2 wks postnally (as seen in textbooks and various studies).
I would like to refer to the work of Sleniste et al in the Pediatric Department of the Danube Hospital, Vienna, Austria. They demonstrated that closure by drug may be attempted before surgical ligation even in cases of advanced postnatal age. They demonstrated this on a 11 wks infant. Their success was confirmed on the third day post treatment by echocardiography.
So colleagues, is it possible in a 20wk old baby?? I could not find the answer. I would be grateful if Narmida could add something on the topic. Thank you.