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Base excess and hematocrit predict response to indomethacin in very low birth weight infants with patent ductus arteriosus.
Ital J Pediatr. 2019 Aug 22; 45(1):107.IJ

Abstract

BACKGROUND

The treatment of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants remains a challenge. The ability to predict which infants will respond to indomethacin could spare some from the risks of unnecessary medications. Our objective was to determine if indicators of acid-base homeostasis could predict response to indomethacin treatment for ductal closure, and thus help guide treatment decisions.

METHODS

We performed a retrospective analysis of medical records of VLBW (< 1500 g) neonates with hemodynamically significant PDA born at our institution between January 2009 and December 2012; all infants included in the study were treated with indomethacin for ductal closure within the first 2 weeks of life. We extracted data for a number of clinical variables including gestational age, birth weight, blood chemistries, surfactant use, hematocrit, and blood gas parameters. Our primary outcome measure was successful closure of PDA following the first round of indomethacin. Using variables that were significant on initial testing, we created multivariable regression models to determine the independent association of selected variables with indomethacin response.

RESULTS

Of the 91 infants included in the study, 62 (68%) responded to the first course of indomethacin with successful ductal closure. Multivariable regression modeling revealed that both base excess and hematocrit were independently associated with indomethacin response; odds of PDA closure increased with increasing base excess (OR [odds ratio]: 1.81; 95% confidence interval [CI]: 1.36-2.60) and increasing hematocrit (OR: 1.21; 95% CI: 1.01-1.45). The optimal cutoff value for base excess was - 4.56, with a sensitivity of 96.8% (95% CI: 89-100) and specificity of 79.3% (95% CI: 60-92); optimal cutoff value for hematocrit was 40, with 69.4% sensitivity (95% CI: 56-80) and 65.5% specificity (95% CI: 46-82).

CONCLUSIONS

Base excess and hematocrit may be independent predictors of indomethacin response in VLBW infants with PDA. Low-cost and readily accessible, acid-base indicators such as base excess could help guide treatment decisions.

Authors+Show Affiliations

Division of Neonatology, Department of Pediatrics, John H. Stroger, Jr. Hospital of Cook County, 1969 W Ogden Avenue, Chicago, IL, 60612, USA. mydamj@gmail.com.Division of Neonatology, Department of Pediatrics, John H. Stroger, Jr. Hospital of Cook County, 1969 W Ogden Avenue, Chicago, IL, 60612, USA.Division of Pediatric Cardiology, Department of Pediatrics, John H. Stroger, Jr. Hospital of Cook County, 1969 W Ogden Avenue, Chicago, 60612, IL, USA.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

31439021

Citation

Mydam, Janardhan, et al. "Base Excess and Hematocrit Predict Response to Indomethacin in Very Low Birth Weight Infants With Patent Ductus Arteriosus." Italian Journal of Pediatrics, vol. 45, no. 1, 2019, p. 107.
Mydam J, Rastogi A, Naheed ZJ. Base excess and hematocrit predict response to indomethacin in very low birth weight infants with patent ductus arteriosus. Ital J Pediatr. 2019;45(1):107.
Mydam, J., Rastogi, A., & Naheed, Z. J. (2019). Base excess and hematocrit predict response to indomethacin in very low birth weight infants with patent ductus arteriosus. Italian Journal of Pediatrics, 45(1), 107. https://doi.org/10.1186/s13052-019-0706-y
Mydam J, Rastogi A, Naheed ZJ. Base Excess and Hematocrit Predict Response to Indomethacin in Very Low Birth Weight Infants With Patent Ductus Arteriosus. Ital J Pediatr. 2019 Aug 22;45(1):107. PubMed PMID: 31439021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Base excess and hematocrit predict response to indomethacin in very low birth weight infants with patent ductus arteriosus. AU - Mydam,Janardhan, AU - Rastogi,Alok, AU - Naheed,Zahra J, Y1 - 2019/08/22/ PY - 2019/06/12/received PY - 2019/08/12/accepted PY - 2019/8/24/entrez PY - 2019/8/24/pubmed PY - 2020/2/12/medline KW - Acidosis KW - Hemodynamically significant PDA KW - Indomethacin KW - Low birth weight KW - Patent ductus arteriosus KW - Preterm SP - 107 EP - 107 JF - Italian journal of pediatrics JO - Ital J Pediatr VL - 45 IS - 1 N2 - BACKGROUND: The treatment of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants remains a challenge. The ability to predict which infants will respond to indomethacin could spare some from the risks of unnecessary medications. Our objective was to determine if indicators of acid-base homeostasis could predict response to indomethacin treatment for ductal closure, and thus help guide treatment decisions. METHODS: We performed a retrospective analysis of medical records of VLBW (< 1500 g) neonates with hemodynamically significant PDA born at our institution between January 2009 and December 2012; all infants included in the study were treated with indomethacin for ductal closure within the first 2 weeks of life. We extracted data for a number of clinical variables including gestational age, birth weight, blood chemistries, surfactant use, hematocrit, and blood gas parameters. Our primary outcome measure was successful closure of PDA following the first round of indomethacin. Using variables that were significant on initial testing, we created multivariable regression models to determine the independent association of selected variables with indomethacin response. RESULTS: Of the 91 infants included in the study, 62 (68%) responded to the first course of indomethacin with successful ductal closure. Multivariable regression modeling revealed that both base excess and hematocrit were independently associated with indomethacin response; odds of PDA closure increased with increasing base excess (OR [odds ratio]: 1.81; 95% confidence interval [CI]: 1.36-2.60) and increasing hematocrit (OR: 1.21; 95% CI: 1.01-1.45). The optimal cutoff value for base excess was - 4.56, with a sensitivity of 96.8% (95% CI: 89-100) and specificity of 79.3% (95% CI: 60-92); optimal cutoff value for hematocrit was 40, with 69.4% sensitivity (95% CI: 56-80) and 65.5% specificity (95% CI: 46-82). CONCLUSIONS: Base excess and hematocrit may be independent predictors of indomethacin response in VLBW infants with PDA. Low-cost and readily accessible, acid-base indicators such as base excess could help guide treatment decisions. SN - 1824-7288 UR - https://www.unboundmedicine.com/medline/citation/31439021/Base_excess_and_hematocrit_predict_response_to_indomethacin_in_very_low_birth_weight_infants_with_patent_ductus_arteriosus_ L2 - https://ijponline.biomedcentral.com/articles/10.1186/s13052-019-0706-y DB - PRIME DP - Unbound Medicine ER -