Pharmacologic closure of patent ductus arteriosus in the premature infant.

The prostaglandins affect smooth-muscle tone of the ductus arteriosus. Patent ductus often complicates the clinical course of prematurely born infants with respiratory-distress syndrome. In the present study, a single oral or rectal dose of a potent inhibitor of prostaglandin synthesis, indomethacin, was administered to six consecutive premature infants with the syndrome who would otherwise have undergone surgical ligation of the patent ductus. Within 24 hours all the clinical symptoms and physical, echocardiographic and radiographic signs attributable to substantial left-to-right shunting through a patent ductus arteriosus dramatically and permanently disappeared. A transient reduction in renal function was observed in two infants in whom sustained ill-effects did not occur. The observation that constriction and closure of the patent ductus arteriosus may be induced pharmacologically raises important possibilities for the improved treatment of the respiratory-distress syndrome.

[1]  D. Sahn,et al.  Echocardiographic Assessment of Left Ventricular Performance in Normal Newborns , 1974, Circulation.

[2]  R. Arcilla,et al.  Congestive heart failure from suspected ductal closure in utero. , 1969, The Journal of pediatrics.

[3]  G. P. Steinmetz,et al.  Incidence and treatment of the patent ductus arteriosus in the ill premature neonate. , 1974, American heart journal.

[4]  M. Heymann,et al.  Effects of Acetylsalicylic Acid on the Ductus Arteriosus and Circulation in Fetal Lambs in Utero , 1976, Circulation research.

[5]  K. Larsson,et al.  Studies on closure of the ductus arteriosus. XII. In utero effect of indomethacin and sodium salicylate in rats and rabbits. , 1975, Prostaglandins.

[6]  H. Nöschel,et al.  [Pharmacokinetics of indomethacin in pregnant and parturient women and in their newborn infants]. , 1973, Zentralblatt fur Gynakologie.

[7]  K. Larsson,et al.  Studies on closure of the ductus arteriosus. XI. Ductal closure in utero by a prostaglandin synthetase inhibitor. , 1974, Prostaglandins.

[8]  D. Sahn,et al.  Echocardiographie Criteria for Normal Newborn Infants , 1973 .

[9]  E. Braunwald,et al.  The prostaglandins. Biochemical, physiologic and clinical considerations. , 1972, The American journal of medicine.

[10]  R. Elliott,et al.  The effects of prostaglandins, prostaglandin inhibitors, and oxygen on the closure of the ductus arteriosus, pulmonary arteries and umbilical vessels in vitro. , 1974, Prostaglandins.

[11]  J. Smith,et al.  Duration of inhibition of platelet prostaglandin formation and aggregation by ingested aspirin or indomethacin. , 1973, Prostaglandins.

[12]  P. Olley.  Nonsurgical Palliation of Congenital Heart Malformations , 1975 .

[13]  S. Matalon,et al.  Mass Spectrometer Evaluation of Ventilation-Perfusion Abnormalities in Respiratory Distress Syndrome , 1974, Pediatric Research.

[14]  C. Hunt,et al.  Patent ductus arteriosus complicating respiratory distress syndrome. , 1975, The Journal of pediatrics.

[15]  N. Silverman,et al.  Closure of the ductus arteriosus in premature infants by inhibition of prostaglandin synthesis. , 1976, The New England journal of medicine.

[16]  W. Oh,et al.  Patent ductus arteriosus complicating the respiratory distress syndrome in preterm infants. , 1975, The Journal of pediatrics.

[17]  J. Neutze,et al.  MEDICAL MANIPULATION OF THE DUCTUS ARTERIOSUS , 1975, The Lancet.

[18]  S. Kaplan,et al.  The critically ill premature infant with patent ductus arteriosus and pulmonary disease-an echocardiographic assessment. , 1975, The Journal of pediatrics.

[19]  J. Vane,et al.  Inhibition of prostaglandin biosynthesis. , 1974, Biochemical pharmacology.

[20]  H. Zuckerman,et al.  Inhibition of Human Premature Labor by Indomethacin , 1974, Obstetrics and gynecology.

[21]  N. Silverman,et al.  Echocardiographic Assessment of Ductus Arteriosus Shunt in Premature Infants , 1974, Circulation.

[22]  F. Mcmahon,et al.  The metabolism of indomethacin in man. , 1972, The Journal of pharmacology and experimental therapeutics.

[23]  E. Sellers,et al.  Binding of Drugs to Serum Albumin , 1976 .

[24]  P. Olley,et al.  E‐Type Prostaglandins: A New Emergency Therapy for Certain Cyanotic Congenital Heart Malformations , 1976, Circulation.