Summary
Pretreatment plasma dilator prostaglandin levels were measured in 16 premature infants with patent ductus arteriosus in an attempt to correlate abnormally elevated levels with clinical responsiveness to indomethacin therapy. Nine of the 16 infants responded well to indomethacin, with complete disappearance of their murmurs by 48 h. Eight of these nine infants had elevated baseline 6 keto PGF1 α levels (>500 pg/ml).
In contrast, seven of the 16 infants did not respond to indomethacin, and six of these had 6 keto PGF1 α within the normal range (<500 pg/ml). PGE2 levels varied in the same general direction, but lacked the specificity and sensitivity of the 6 keto PGF1 α levels. Thus, 6 keto PGF1 α levels seem to correlate with, and may eventually be helpful in predicting, clinical indomethacin responsiveness in the premature neonate with patency of the ductus arteriosus.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Alpert B, Lewins M, Rowland D, Grand M, Olley P, Soldin S, Swyer P, Coceani F, Rowe R (1979) Plasma indomethacin levels in preterm newborn infants with symptomatic patent ductus arteriosus: clinical and echocardiographic assessments of response.J Pediatr 95:578–582
Bhat R, Vidyassagar D, Fisher E, Hastreiter A, Ramirez J, Burns L, Evans M (1980) Pharmacokinetics of oral and intravenous indomethacin in preterm infants.Dev Pharmacol Ther 1:101–110
Brash A, Hickey D, Graham T, Stahlman M, Oates J, Cotton R (1981) Pharmacokinetics of indomethacin in the neonate.N Engl J Med 305:67–72
Clyman R, Mauray F, Koerper M, Wiemer F, Heymann M, Rudolph A (1978) Formation of prostacyclin (PGI2) by the ductus arteriosus of fetal lambs at different stages of gestation.Prostaglandins 16:633–641
Clyman R, Mauray F, Roman C, Rudolph A (1978) PGE2 is a more potent vasodilator of the lamb ductus arteriosus than is either PGI or 6 keto PGF1 α.Prostaglandins 16:259–264
Coker S, Clarke B, Zeitlin I (1982) Radioimmunoassay techniques for the determination of the local release of prostaglandins and thromboxanes.J Pharmacol Methods 7:207–217
Cotton RB, Stahlman M, Bender H, Graham T, Catterton W, Kovar I (1978) Randomized trial of early closure of symptomatic patent ductus arteriosus in small premature infants.J Pediatr 93:647–651
Fitzpatrick F, Gorman R, McGuire J, Kelly R, Wynalda M, Sun F (1977) A radioimmunoassay for thromboxane B2.Anal Biochem 82:1–7
Friedman W, Fitzpatrick K (1980) Effects of prostaglandins, thromboxanes and inhibitors of their synthesis on renal and gastrointestinal function in the newborn period.Semin Perinatol 4:143–156
Friedman Z, Demers L (1978) Essential fatty acids, prostaglandins and respiratory distress syndrome of the newborn.Pediatrics 61:341–346
Friedman Z, Whitman V, Maisels J, Berman W, Marks K, Vesell E (1978) Indomethacin disposition and indomethacin-induced platelet dysfunction in premature infants.J Clin Pharmacol 18:272–279
Gersony W, Peckham G, Ellison R, Miettinen O, Nadas A (1983) Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study.J Pediatr 102:895–906
Hammerman C, Strates E, Berger S, Zaia W, and Aldousany A (1986) Prostaglandins and systolic time intervals in the assessment of patent ductus arteriosus.Crit Care Med 14:462–465
Hammerman C, Zaia W, Lee K (1983) Do plasma prostaglandin levels predict patent ductus arteriosus development? [abstr].Soc Pediatr Res 17:315A
Harris J, Merritt T, Alexson C, Longfield L, Manning J (1982) Parenteral indomethacin for closure of the patent ductus arteriosus.Am J Dis Child 136:1005–1008
Lucas M, Mitchell A (1978) Plasma prostaglandins in preterm neonates before and after treatment for patent ductus arteriosus.Lancet 2:130–132
McCarthy J, Zies L, Gelband H (1976) Age-dependent closure of the patent ductus arteriosus by indomethacin.Pediatrics 62:706–711
Mellander M, Jeheup B, Lindsterom D, Palme C, Graham T, Stahlman M, Cotton R (1984) Recurrence of symptomatic patent ductus arteriosus in extremely premature infants treated with indomethacin.J Pediatr 105:138–143
Neal W, Kyle J, Mullett M (1977) Failure of indomethacin therapy to induce closure of patent ductus arteriosus in premature infants with respiratory distress syndrome.J Pediatr 91:621–623
Pace-Asciak C, Rangaraj G (1977) The 6 keto PGF1 α pathway in the lamb ductus arteriosus.Biochem Biophys Acta 486:583–585
Seyberth H, Muller H, Wille L, Pluckthun H, Wolf D, Ulmer H (1982) Recovery of prostaglandin production associated with reopening of the ductus arteriosus after indomethacin treatment in preterm infants with respiratory distress syndrome.Pediatr Pharmacol 2:127–141
Vert P, Bianchetti G, Marchal F, Monin P, Morselli P (1980) Effectiveness and pharmacokinetics of indomethacin in premature infants with PDA.Eur J Clin Pharmacol 18:83
Yeh T, Luken J, Raval D, Thalji A, Carr I, Pildes R (1983) Indomethacin treatment in small versus large premature infants with ductus arteriosus: comparison of plasma indomethacin concentration and clinical response.Br Heart J 50:27–30A0946026 00002 CS-SPJRNPDF [HEADSUP]
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hammerman, C., Zaia, W., Berger, S. et al. Prostaglandin levels: Predictors of indomethacin responsiveness. Pediatr Cardiol 7, 61–65 (1986). https://doi.org/10.1007/BF02328952
Issue Date:
DOI: https://doi.org/10.1007/BF02328952