Am J Perinatol
DOI: 10.1055/a-1827-7674
Original Article

Relationship between Decrease in Urine Output following Treatment with Prostaglandin Inhibitors and PDA Closure

Malika Goel
1   Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
,
1   Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
,
Shiv Sajan Saini
1   Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
,
Venkataseshan Sundaram
1   Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
› Author Affiliations
Funding None.

Abstract

Objective Prostaglandin inhibitors are used for the treatment of patent ductus arteriosus (PDA) and they often transiently decrease the urine output (UO) due to prostaglandin inhibition in the renal vasculature. We hypothesized that preterm infants whose renal vasculature shows greater sensitivity to prostaglandin inhibitors are likely to have ductal tissue with greater sensitivity to the same. Our objective was to determine whether the decrease in UO following treatment of PDA with a prostaglandin inhibitor is associated with a higher probability of PDA closure.

Study Design In a prospective, proof-of-concept, cohort study, we enrolled 40 preterm neonates with hemodynamically significant PDA (hsPDA), being treated with a prostaglandin inhibitor. The key predictor, UO, was measured at baseline and daily until 72 hours. We repeated echocardiography daily until PDA closure or the end of treatment. The key outcome was PDA closure. We compared “PDA-closed” (n = 28) and “PDA-open” (n = 12) groups for change in UO from baseline.

Results The median (Q1, Q3) percent decrease in UO (figures rounded off to integers) was greater in the “PDA-closed” versus “PDA-open” group: from baseline to 0 to 24 hours [−45% (−55%, +0.04%) vs. −15% (−28%, +49%)]; baseline to 24 to 48 hours [−41% (−53%, +14%) vs. −3% (−25%, +62%), p = 0.03] and baseline to 48 to 72 hours [−33% (−49%, +32%) vs. +21% (−7%, +98%), p = 0.02]. Decrease in UO preceded PDA closure. The “PDA-closed” group had significantly greater weight loss, despite a greater decrease in UO. A decrease in UO of 27 and 17% by 24 to 48 hours and 48 to 72 hours, respectively, best predicted PDA closure.

Conclusion A decrease in UO after treating hsPDA with a prostaglandin inhibitor is associated with successful closure of PDA.

Key Points

  • Prostaglandin inhibition causes both decrease in urine output and PDA closure following medical treatment

  • The association between drug-induced decrease in urine output and PDA closure has been inadequately studied.

  • Decrease in urine output after treatment with prostaglandin inhibitors increases the chances of PDA closure.

Ethical Approval Statement

The protocol of the study was approved by the Institute Ethics Committee (approval number INT/IEC/2017/547 dated May 05, 2017).


Supplementary Material



Publication History

Received: 28 October 2021

Accepted: 13 April 2022

Accepted Manuscript online:
18 April 2022

Article published online:
31 May 2022

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