Indomethacin-Induced Early Patent Ductus Arteriosus Closure Cannot Be Predicted by a Decrease in Pulse Pressure

Wide pulse pressure is considered to be a sign of patent ductus arteriosus (PDA). We tested the hypothesis that, following indomethacin therapy, PDA closure is associated with a significant decrease in pulse pressure. Thirty-two ventilated preterm infants were echocardiographically diagnosed within the first 24 hours of life with PDA. Systolic, diastolic, and mean arterial blood pressures were measured prior to indomethacin treatment and after echocardiographically confirmed PDA closure. Following PDA closure, systolic and diastolic blood pressures and mean arterial pressure increased significantly without a significant change of pulse pressure (17 ± 7 to 20 ± 12 torr). We conclude that in preterm infants with PDA, systolic, diastolic, and mean arterial blood pressures increase significantly within first few days of life. Pulse pressure does not appear to be affected by early PDA closure. We speculate that high pulmonary resistance in the first days of life prevents significant diastolic aortic runoff and leaves pulse pressure unaffected by PDA, as well as by its closure.

KEYWORDS

Pulse pressure - indomethacin - echocardiography - preterm infants

REFERENCES

• 1 Bernstein D. Acyanotic congenital heart diseases: the left-to-right shunt lesions. In: Behrman RE, Kliegman RM, Jenson HB Nelson Textbook of Pediatrics, 16th ed. Philadelphia; Saunders 2000: 1372-1373
• 2 Wilkinson J, Cooke R WI. Cardiovascular problems of the newborn. In: Robertson NRBC Textbook of Neonatology. London; Churchill Livingston 1986: 342
• 3 Moore P, Brook M M, Heymann M A. Patent ductus arteriosus. In: Allen HD, Gutgesell HP, Clarck EB, Driscol DJ Moss and Adam's Heart Disease in Infants, Childhood, and Adolescent, 6th edition. Philadelphia; Lippincott Williams & Wilkins 2001: 652-669
• 4 Ratner I, Perelmuter B, Toews W, Whitfiels J. Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant.  Crit Care Med. 1985;  13 497-500
• 5 Evans N, Moorcraft J. Effect of patency of the ductus arteriosus on blood pressure in very preterm infants.  Arch Dis Child. 1992;  67 1169-1173
• 6 Evans N, Iyer P. Change in blood pressure after treatment of patent ductus arteriosus with indomethacin.  Arch Dis Child. 1993;  68 584-587
• 7 Garland J, Buck R, Weinberg M. Pulmonary hemorrhage risk in infants with a clinically diagnosed patent ductus arteriosus: a retrospective cohort study.  Pediatrics. 1994;  94 719-723
• 8 Kluckow M, Evans N. Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage.  J Pediatr. 2000;  137 68-72
• 9 Tomaszewska M, Stork E, Minich N M, Friedman H, Berlin S, Hack M. Pulmonary hemorrhage: clinical course and outcomes among very low-birth-weight infants.  Arch Pediatr Adolesc Med. 1999;  153 715-721
• 10 Lee J, Rajadurai V S, Tan K W. Blood pressure standards for very low birthweight infants during the first day of life.  Arch Dis Child Fetal Neonatal Ed. 1999;  81 F168-F170
• 11 Sonesson S E, Lundell B P, Herin P. Changes in intra-cranial arterial blood flow velocities during surgical ligation of the patent ductus arteriosus.  Acta Paediatr Scand. 1986;  75 36-40