INDOMETHACIN

Indomethacin is used to treat patent ductus arteriosus and, on a different dosing schedule, to prophylactically decrease the risk of intraventricular hemorrhage. PDA in infants with RDS complicates mechanical ventilation, and is associated with BPD, decreases in cerebral, mesenteric, and renal blood flow, and CHF. Indomethacin, by inhibiting prostaglandin synthesis, allows the ductus to constrict in a high proportion of treated infants. Reversible renal insufficiency often occurs and fluid status must be carefully watched. Because significant oliguria can occur, fluids may need to be restricted to prevent fluid overload and dilutional hyponatremia. Do not follow BUN/Cr during Indomethacin therapy as they predictably rise.

• Contraindications: Pulmonary hemorrhage, NEC or suspected NEC
• Relative contraindications: Cr >2.0 mg%, or platelets <75,000

IVH Prophylaxis

Qualifying Patients:

• Birthweight <1250 grams
• Intubated and mechanically ventilated
• Day one of life

  Contraindications:

• pulmonary hemorrhage
• NEC or suspected NEC

  Relative Contraindications:

• Creatinine >2.0mg%
• Platelets < 75K

DOSE #	TIME	DOSE
1	0	O.1mg/kg
2	24h	O.1mg/kg
3	48h	O.1mg/kg

Dose: 0.1mg/kg/day x 3 days

PDA Treatment

When treating for a PDA, use the following protocol (dosing time refers to from when the initial dose is given):

Dosage (mg/kg/dose) & Time

Age at First Dose	1st (time 0)	2nd (12h)	3rd (36h)
<= 7 days	0.2	0.1	0.1
>= 7 days	0.2	0.2	0.2

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