- Treatment of hemodynamically significant patent ductus arteriosus (HS-PDA) in infants born at or > 29 weeks gestation
- IV intermittent infusion: over 20 - 30 minutes
Patent Ductus Arteriosus, Treatment Dosage:
- Course of 3 doses given Q12h
|
Age at First Dose |
First Dose (mg/kg) |
Second Dose (mg/kg) |
Third Dose (mg/kg) |
|
2 - 7 days |
0.2 |
0.2
|
0.2 |
|
> 7 days |
0.2
|
0.25
|
0.25 |
NOTE: Use 12-hour dosing if urine output > 1 mL/kg/hour since last dose; use 24 hour dosing interval if urine output is < 1 mL/kg/hour but > 0.6 mL/kg/hour; doses should be withheld if patient has oliguria (urine output < 0.6 mL/kg/hour) or anuria
- CVS: hypertension, edema, body fluid retention
- Endocrine and metabolic: hyperkalemia, dilutional hyponatremia, hyper-/hypoglycemia
- GI: vomiting, abdominal distension, GI bleed, necrotizing enterocolitis, perforation
- Hematologic: can inhibit platelet aggregation and may prolong bleeding time, neutropenia
- Renal: increase in urea and serum creatinine, transient decrease urine output
- Serum creatinine and urea, bilirubin, electrolytes, glucose, platelets prior to start of therapy then serially as required
- Urine output
- Abdominal distension
- Signs of bleeding
- Indomethacin 1 mg
- Add 2 mL of 0.9% NaCl. Take 2 mL (1 mg) and add to 8 mL of 0.9% NaCl
- Final concentration: 0.1 mg/mL
- Solutions Compatible: D5W, NS
- Incompatibility: D7.5W, D10W, TPN, do not mix with any other drugs
- Contraindications:
- Active bleeding, coagulation defect
- Evolving severe intracranial hemorrhage (IVH) (Grades III or IV)
- Thrombocytopenia (platelet count less than 50 x 109/L)
- Significant impairment of renal function
- Known or suspected NEC
- Hyperbilirubinemia (relative contraindication)
- Brunner et al. Patent Ductus Arteriosus, Low Platelets, Cyclooxygenase Inhibitors, and Intraventricular Hemorrhage in Very Low Birth Weight Preterm Infants. J Pediatr, 25 Jan 2013 (access www.jpeds.com)
- Fowlie, P. W. and Davis, P.G. (2010), Cochrane Review: Prophylactic Intravenous Indomethacin for Preventing Mortality and Morbidity in Preterm Infants. Evid.-Based Child Health, 5: 416-471. doi: 10.1002/ebch.526
- Kelleher J et al. Prophylactic Indomethacin and Intestinal Perforation in Extremely Low Birth Weight Infants. Pediatrics. 2014
- Barbara Schmidt, MD et al. Effects of Prophylactic Indomethacin in Extremely Low-Birth-Weight Infants With and Without Adequate Exposure to Antenatal Corticosteroids
- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22th Edition. Hudson: Lexi-Comp Inc.; 2015