634 Effect of Indomethacine Infusion Rate for Patent Ductus Arteriosus on Cerebral Oxygenation in Preterm Infants

Abstract

Background: Indomethacine treatment for patent ductus arteriosus (PDA), might lead to vasoconstriction of cerebral blood vessels and under-perfusion of the brain. A lower infusion rate might prevent this. We aimed to determine the effect of two indomethacine infusion rates on fractional cerebral oxygen extraction (FTOE), which is indicative for cerebral blood flow.

Methods: In preterms with PDA, we compared the effect of indomethacine infusion (0.2 mg/kg) in 30 versus 60 minutes, on cerebral oxygenation. Patients in both groups were matched for GA, BW, PDA closure, and postnatal age. Near-infrared spectroscopy was used to measure regional cerebral oxygen saturation (r_cSO₂). Transcutaneous arterial oxygen saturation (tcSaO₂) was measured simultaneously. FTOE was calculated: (tcSaO₂- r_cSO₂)/tcSaO₂. We analyzed 6 episodes of 1-h measurements: before, 1h-4h, and 12 hours after treatment, using Mann-Whitney-U-test.

Results: Twenty infants (13 girls, median GA 27.0 weeks (range 25.3-28.7), BW 1007 gram (615- 1300), age 3.0 days (2-11)) were included, 10 in each group. No significant differences existed between the groups regarding GA, BW, age, effectiveness of indomethacine, need of surgery, and gender. The first hour after the start of treatment, we found an increase in FTOE of 0.04 in the 30 minutes-infusiongroup, compared to no change in FTOE in the 60-minutes-infusion group (p=.03). No significant differences were found at all other time-points.

Conclusion: Higher infusion rate of indomethacine for PDA seems to decrease cerebral blood flow the first hour, compared to lower infusion rate, possibly due to indomethacine induced vasoconstriction. The clinical relevance of this difference needs to be Investigated.

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