INCREASED RISK OF NECROTIZING ENTEROCOLITIS IN PREMATURE-INFANTS WITHPATENT DUCTUS-ARTERIOSUS TREATED WITH INDOMETHACIN

Objective The authors evaluated the risk of necrotizing enterocolitis (NEC) in very low birth weight infants receiving indomethacin (INDO) t o dose patent ductus arteriosus (PDA). Background Data Controversy exi sts regarding the best method of managing very low birth weight infant s with PDA and whether to employ medical management using INDO or surg ical ligation of the ductus. Methods Two hundred fifty-two premature i nfants with symptomatic PDA were given intravenously INDO 0.2 mg/kg ev ery 12 hours X 3 in an attempt to close the ductus. Patients were eval uated for sex, birth weight, gestational age, ductus closure, occurren ce of NEC, bowel perforation, and mortality. Results There were 135 bo ys and 117 girls. The PDA closed or became asymptomatic in 224 cases ( 89%), whereas 28 (11%) required surgical ligation. Ninety infants (35% ) developed evidence of NEC after INDO therapy. Fifty-six were managed medically; surgical intervention was required in 34 of 90 cases (37.8 %) or 13% of the entire PDA/INDO study group. Bowel perforation was no ted in 27 cases (30%). Factors associated with the onset of NEC includ ed gestational age < 28 weeks, birth weight < 1 kg, and prolonged vent ilator support. The overall mortality rate was 25.5%, but was higher i n infants with NEC versus those without. The highest mortality was not ed in perforated NEC cases. The PDA/INDO patients were compared with a control group of 764 infants with similar sex distribution, birth wei ghts, and gestational ages without PDA who did not receive INDO. Necro tizing enterocolitis occurred in 105 of 764 control patients (13.7%), including 13 (12.3%) with perforation. The overall mortality rate for controls was 25%, which was similar to the overall 25.5% mortality rat e in the PDA/INDO study group. Conclusion These data indicate that the re is increased risk of NEC and bowel perforation in premature infants with PDA receiving INDO. Mortality was higher in the PDA/INDO group w ith NEC than those PDA/INDO infants without NEC.