Indomethacin treatment in small versus large premature infants with ductus arteriosus. Comparison of plasma indomethacin concentration and clinical response.

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Abstract
An analysis of clinical response and plasma indomethacin concentration was performed on 10 small (.ltoreq. 1000 g) and 12 large (> 1000 g) premature [human] infants who had symptomatic ductus arteriosus and required i.v. indomethacin therapy (0.3 mg/kg per day). The postnatal age, daily fluid intake, and cardiopulmonary status of the 2 groups at time of study were comparable. The small premature infants had a significantly lower peak plasma indomethacin concentration and lower concentration in the first 4 h after infusion, and lower plasma concentration .times. time integral than that of the larger premature infants. There was a significant difference between the groups in proportion of response (2/10 vs. 9/12) after 1 dose of indomethacin; this difference was not seen after 2-3 doses. Apparently, small premature infants do respond to indomethacin treatment, but compared to the larger infants may require repeated doses.