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Prophylactic indomethacin can harm very low birthweight babies with severe CHD

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A 12 year review of very low birthweight babies with severe congenital heart disease (CHD) has discovered that prophylactic indomethacin for patent ductus arteriosus can compromise a poor outcome still further. The risk would be significant if indomethacin treatment were to increase, claim the researchers.

Mortality was significantly higher in babies with CHD than without (40%, 19/47 v 13% 247/1973), and mortality due to CHD specifically was also significantly higher, at 32% (15/47). Ventricular septal defect was the most common abnormality (27/47) but by itself did not cause death. Mortality rose still further once these cases were excluded. The second most common abnormality was coarctation of the aorta, present in eight babies. Five of these babies died, four who weighed ≤1000 g at birth. Six of the eight babies had indomethacin for patent ductus arteriosus before coarctation was diagnosed, and in three their condition got dramatically worse afterwards.

Sixteen babies were operated on, and seven died. Babies with coarctation had the poorest outcome: two died before their operation, and three of the six who had their abnormality corrected died; their birth weight was ≤1000 g.

The study was based on data from the case notes of babies born between 1 January 1988 and 31 December 1999 in one hospital, 2020 ≤1500 g and 760 ≤1000 g, who had severe CHD.

CHD occurs in 3–12/1000 live births. Its specific effect on very low birthweight babies has not been reported before.