We performed a double-blind, controlled study of prophylactic indomethacin therapy in 47 premature infants (<1700 g) who had subclinical patent ductus arteriosus. They received either indomethacin or placebo at a mean age of 2.9 days. Among the 25 infants weighing more than 1000 g, a hemodynamically important ductus shunt developed in only four of the 14 given placebo. The incidence of important shunts, the number of surgical ligations, and the duration of oxygen therapy were not appreciably different between the study groups. In contrast, among the 22 infants who weighed 1000 g or less, a major ductus shunt developed in 10 of the 12 given placebo. In the smaller infants indomethacin therapy was associated with a significantly lower incidence of major shunts, fewer surgical ligations, a decreased duration of oxygen therapy, and fewer days necessary to regain birth weight. We conclude that prophylactic indomethacin therapy in infants weighing under 1000 g prevents the later development of large ductus shunts and decreases morbidity. (N Engl J Med. 1982; 306:506–10.) A HEMODYNAMICALLY important shunt through a patent ductus arteriosus is a major problem among premature infants.1,2 A large left-to-right shunt through a patent ductus arteriosus has been associated with increased incidences of bronchopulmonary dysplasia, necrotizing enterocolitis, intracranial hemorrhage, and death.3,4 Surgical ligation of the ductus arteriosus has been shown to decrease the duration of mechanical ventilation, to improve caloric intake,5 and to increase lung compliance6 in premature infants with a large left-to-right shunt and respiratory distress. Several recent studies have shown that pharmacologic constriction of the ductus arteriosus with indomethacin, which was first described in 1976,7,8 is effective in the.
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