[New aspects in the treatment of patent ductus arteriosus in premature newborns with respiratory insufficiency].

The efficacy of prolonged indomethacin treatment of sPDA was studied using a new, diagnostic method, the two-dimensional Doppler echocardiography (2-DDE). 35 ventilated preterm infants with sPDA (gestational age: 31.6 +/- 2.6; birth weight: 1535 +/- 565 gms) were studied prospectively. Therapy consisted of a loading and maintenance dose (3 x 0.3 mg/kg I. 12 h, 2 x 0.15 mg/kg I. 24 h). Therapy was initiated at postnatal age 1 to 17 days. Echocardiographycally verified closure of sPDA was achieved in 27/35 patients (77%), one patient had a relapse (4%), 8/35 (23%) did not respond to indomethacin. Responders were treated earlier (4.5 vs 9.6 days), were ventilated over a shorter period (30 vs 57 days) and exposure time to more than 30% of FiO2 was shorter (28 vs 56 days). Prolonged indomethacin is an effective treatment of sPDA in ventilated prematures. Early start of therapy increases rate of closure. For precise diagnosis of hemodynamic effectiveness 2-DDE method is mandatory.