FATAL HEMORRHAGIC GASTRITIS ASSOCIATED WITH ORAL SULINDAC TREATMENT FOR PATENT DUCTUS-ARTERIOSUS

We report the first case in a preterm infant given oral sulindac for t reatment of symptomatic patent ductus arteriosus who subsequently deve loped severe acute haemorrhagic gastritis leading to disseminated intr avascular coagulation, massive pulmonary haemorrhage and death. The po stmortem examination suggested that the mechanism was likely a direct irritant insult causing ischaemia on the gastric mucosa. Although suli ndac is supposed to be a renal-sparing non-steroidal anti-inflammatory prodrug associated with minimal renal and gastrointestinal adverse ef fects, clinicans should be alerted to this potential life-threatening complication in preterm infants. Until the question of safety could be adequately addressed, the use of sulindac for ductal closure should r emain experimental.