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Query: UMLS:C0476273 (respiratory distress)
 19,632 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Indomethacin is currently used for the pharmacologic closure of PDA in preterm infants with respiratory distress syndrome. However, the response to the drug has been variable and the disposition of the drug in preterm infants is not well understood. We studied the pharmacokinetics of indomethacin in nine preterm infants with birth weights ranging from 800 to 1,960 gm and gestational ages of 28 to 36 weeks. Three different dose schedules (0.1, 0.25, 0.3 mg/kg dose) were used. The plasma half-life of indomethacin ranged from 11 to 20 hours. Peak levels were achieved within four hours and ranged from 0.027 to 0.310 microgram/ml. The half-life in infants less than 32 weeks' gestation was significantly prolonged compared to that in infants greater than 32 weeks. Protein-binding studies with 14C indomethacin showed that 98% of indomethacin was protein bound. Absorption of orally administered indomethacin appears to be poor and incomplete. No immediate major complications could be correlated to indomethacin therapy in this study.
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PMID:Disposition of indomethacin in preterm infants. 44 76

The reported effects of indomethacin on pulmonary compliance are variable depending upon the patient population and on the degree to which indomethacin resulted in successful ductal closure. Eleven fluid-restricted, furosemide-treated premature infants being mechanically ventilated for respiratory distress syndrome (RDS) who also had a significant patent ductus arteriosus (PDA) had pulmonary function testing performed before and after successful closure of the PDA. The diagnosis of a significant PDA was made by clinical and echocardiographic criteria. Indomethacin was administered at a dosage of 0.2 mg/kg/dose every 12 to 18 h for 1 to 3 doses. To control for the 48-h time interval to achieve ductal closure, nine premature infants being ventilated for RDS but who did not have a significant PDA also had pulmonary function evaluations performed before and after the 48 h. Also, to control for the independent effect of fluid restriction and diuretic therapy on pulmonary compliance, eight such premature infants with a PDA had pulmonary function evaluations performed at a 48-h interval. Successful closure of the ductus with indomethacin was associated with an improvement in compliance and ventilation parameters in all infants in the indomethacin-treated infants. In the indomethacin-treated group, the mean percent improvements were noted in the following parameters: CLdyn, 59.2%; CLI, 78.3%; CLE, 63.3%; VT, 63.3%; VE, 54.6%. There were no significant changes in the pulmonary functions in the 48-h RDS or the 48-h PDA fluid-restricted, furosemide-treated control groups. In conclusion, successful closure of the ductus with indomethacin causes a significant improvement in compliance and ventilation parameters in infants being mechanically ventilated for RDS.
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PMID:Closure of the ductus arteriosus with indomethacin in ventilated neonates with respiratory distress syndrome. Effects of pulmonary compliance and ventilation. 199 Sep 34

Between October 1981 and December 1983 21 premature infants of mean gestational age 27.5 weeks (range 26-29 weeks) underwent surgical closure of persistent ductus arteriosus. Mean birth weight was 1080 g. There was no operative mortality. One death in an infant with pseudomonas septicaemia occurred two days after surgery. Twenty infants had features of idiopathic respiratory distress syndrome (IRDS) and required assisted ventilation prior to operation. Six infants had associated bronchopulmonary dysplasia (BPD) and 11 had signs of congestive cardiac failure. All infants presented with clinical features suggesting the diagnosis of PDA and in 18 the left atrial/aortic ratio was increased (mean 1.9:1). In 18 infants a trial of Indomethacin therapy had failed. This experience supports the view that surgical closure of PDA in infants born before 30 weeks gestation can be accomplished safely. We believe that surgical treatment of PDA represents the optimal therapy in this high risk group of infants.
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PMID:Surgical closure of persistent ductus arteriosus (PDA) in infants before 30 weeks gestation. 353 49

BW775C, an inhibitor of the lipoxygenase and cyclo-oxygenase pathways, inhibits the respiratory distress induced by arachidonic acid in rats. The degree of respiratory distress was measured in terms of respiratory rate using electrodes implanted at each side of the thorax. Indomethacin, an inhibitor of the cyclooxygenase pathway, failed to influence the respiratory distress induced by arachidonic acid. The results implicate the lipoxygenase pathway, i.e. the leukotrienes synthesis inhibition, in the respiratory distress induced by arachidonic acid.
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PMID:The effect of BW775C on respiratory distress in the rat induced by arachidonic acid. 391 25

Perinatal anoxia, or postnatal hypoxemia, as seen during respiratory distress syndrome, profoundly affects renal function. Hypoxemic neonates present with decreased water excretion, impaired diluting ability, urine acidification, glomerular filtration rate and renal perfusion. Stimulation of the renin-angiotensin system may explain, at least in part, the pathogenesis of the hypoxemia-induced renal changes. The renal defects are reversible upon restoring normoxemia, extracellular fluid volume and cardiac output. The neonatal kidney can also be affected by iatrogenic manipulations. Drugs acting efficiently on several target-organs can profoundly impair renal function. Tolazoline, sometimes used as a pulmonary vasodilator in persistent pulmonary hypertension of the premature infant, can increase renal vascular resistance with consequent renal failure. Indomethacin, a prostaglandin-synthetase inhibitor used to medically close a patent ductus arteriosus, can depress glomerular filtration and water excretion in the newborn infant. Aminoglycosides are widely used in neonatology. They can easily accumulate in neonates whose GFR is low. Their nephrotoxicity may be lower in neonates than in adults, but is certainly not negligible. Experimental studies and a clinical observation have shown that captopril, a competitive inhibitor of the angiotensin-converting enzyme can produce renal damage in the fetus. Recent progress in pharmacology has provided the neonatologist with effective drugs which are of great value in the neonatal ward. They should however always be used with caution if detrimental side-effects are to be avoided.
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PMID:[Renal disorders in the newborn infant]. 639 26

In a 13-month period, ligation of the persistent ductus was carried out in 23 prematurely born babies with severe respiratory distress syndrome who were all respirator-dependent. Mean gestational age was 30.6 weeks (26-36 weeks), mean birth weight 1490 g (850-3090 g) with 3 patients under 1000 g. Signs of cardiac failure by large left to right shunt via ductus were seen at the end of the first week of life, radiologic signs as pulmonary edema were seen 1 to 2 days earlier. Mean age at operation was 13.5 days (4-27 days), mean duration of artificial ventilation 22 days (8-59 days). Indomethacin was used orally 12 of these patients without effect to close the ductus. One patient died of cerebral hemorrhage on his 17th day of life, 10 days postoperatively, one 3 1/2 months later at home with porencephaly and hydrocephalus. Four patients show radiologic signs of bronchopulmonary dysplasia. In the following 6 months up to December 1979, another 15 patients with IRDS underwent ductus ligation. Gestational age and birth weights were about the same as in the first group. Out of this second group which has not been followed up for a longer period. 3 babies died. Early mortality in both groups is 10.5% (4 out of 38 patients).
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PMID:[Ductus ligation in idiopathic respiratory distress syndrome of the premature infant]. 744 Feb 30

The aim of this randomized study was to compare the neonatal outcome in infants who have been exposed in utero to indomethacin with that in infants exposed to a beta-adrenergic agonist, nylidrin hydrochloride. Eighty pregnant women threatened with preterm labor between 24 and 34 weeks of gestation were enrolled in the study. An intravenous infusion of nylidrin or enterally administered indomethacin was given for a maximum of 72 hours. If preterm labor recurred, all parturient patients were treated with nylidrin. Indomethacin prolonged gestation significantly more than the beta-adrenergic agonist (6.6 weeks vs 4.5 weeks; p = 0.04). Ten of the forty-two infants exposed to indomethacin and 2 of the 45 infants exposed to nylidrin had bronchopulmonary dysplasia (24% vs 5%; p = 0.02). Among the 28 infants delivered within 120 hours after the start of treatment, the incidences of respiratory distress syndrome (82% vs 29%; p = 0.02), bronchopulmonary dysplasia (73% vs 6%; p = 0.0006), and necrotizing enterocolitis or focal intestinal perforation (27% vs 0%; p = 0.03) were higher among those exposed to indomethacin than among those exposed to nylidrin. We infer that administration of indomethacin to pregnant women threatened with premature labor is associated with an increased risk of bronchopulmonary dysplasia in their infants if delivery occurs early.
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PMID:Increased incidence of bronchopulmonary dysplasia after antenatal administration of indomethacin to prevent preterm labor. 817 60

Indomethacin (Indo) is commonly used for treatment of patent ductus arteriosus (PDA) but has renal failure as a main side effect. Aspirin (ASA) is an alternative, but there are no controlled trials on its efficacy. We randomly assigned 75 premature infants suffering from respiratory distress syndrome (RDS) (mean gestational age: 29.6 +/- 2.5 wk, mean birth weight: 1295 +/- 464 g) (+/- SD) and on artificial ventilation at the start of the study (mean: 3.4 d of life), to either Indo (3 x 0.2 mg/kg/12 h) or ASA (4 x 15 mg/kg/6 h). PDA and degree of shunting were evaluated by echocardio-Doppler; side effects were carefully recorded. PDA closed in 35/38 patients from the Indo group (92%) and in 16/37 patients from the ASA group (43%) (p < 0.0001). Nineteen patients needed further treatment with Indo or surgery (17 in the ASA group and 2 in the Indo group). The only side effect observed was a decrease of uresis in the Indo group during 4 d post treatment (p < 0.01). Closing of PDA was positively correlated with gestational age, but not with time of starting Indo/ASA or grade of shunting. We conclude that ASA is not as effective in closing PDA as Indo, but has no adverse effect on uresis.
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PMID:Aspirin versus indomethacin treatment of patent ductus arteriosus in preterm infants with respiratory distress syndrome. 861 89

Eighteen preterm infants severely ill with respiratory distress syndrome who required assisted ventilaton were given modified natural surfactant (Survanta) endotracheally. They had a mean +/- SEM gestational age of 31.2 +/- 0.4 weeks (range 28-34) and a mean +/- SEM birthweight of 1562 +/- 71 g (range 1160-2010). Average time of initial surfactant administration was 15 +/- 1.7 hour (range 5-24). No significant side effects were found during surfactant instillation. Post surfactant, the air entry was improved, oxygenation and arterial/alveolar gradients increased, and the levels of inspired oxygen could be reduced. Some of the radiological abnormalities were resolved. In 13 infants, patent ductus arteriosus became clinically evident, seven of whom received Indomethacin. There were 4 cases of pulmonary air leak, 5 cases of pulmonary hemorrhage and 8 cases of bronchopulmonary dysplasia. Four infants expired, two were due to severe asphyxia/shock and two died of unrelated causes. Among the 14 survivors who came for follow-up, two cases of retinopathy of prematurity had gradually regressed, one had cerebral palsy and delayed development. Surfactant rescue therapy is a supplemental beneficial treatment for severe respiratory distress syndrome while newborn intensive care concept is necessary for efficient diagnosis and treatment of RDS.
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PMID:Surfactant treatment in the neonate with severe respiratory distress syndrome. 870 7

This is a prospective and experimental trial with the objective of treating pregnancies complicated with symptomatic polyhydramnios. Patients with pregnancies between 24 and 25 weeks, index of amniotic fluid greater than 24 and with symptoms associated to polyhydramnios such as abdominal discomfort, respiratory distress and premature uterine contractions, were entered into the trial. The medication utilized was Indomethacin 25 mg p.o. every six hours until symptoms disappear and the index of amniotic fluid was less than 24. Eight patients were treated during an eight months period. The average age was 30 years, with a rank between 25 and 37 years. There were only two nulliparous and the average gestational age was 30 weeks. The patients were classified in this way: three with idiopathic polyhydramnios, two with twin pregnancies, one with diabetes mellitus and two pregnancies, one with diabetes mellitus and two pregnancies with fetal malformations. 18 trisomy was diagnosed in the newborn from one of the patients with idiopathic polyhydramnios. The average index of amniotic fluid upon initiating the treatment was of 33.6 and 18 upon finishing. The maximum treatment time was six days with average four. Ultrasonographic control was obtained every 24 hours and fetal echocardiogram at 24 and 96 hours of treatment. There were no maternal nor fetal side effects. Success rate correcting symptomatic polyhydramnios with Indomethacin was 100%.
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PMID:[Pregnancy complicated with symptomatic polyhydramnios: treatment with indomethacin]. 907 5


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