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Re: IndomethacinFrom: Ira Mark Bernstein (ibernste@moose.uvm.edu)Tue Jul 30 09:55:46 1996
>I salute you on your use of Indomethacin. As you know not only is it >cost effective, but it works!! >I think with weekly AFI's and Ductal flow evaluation, you will see >that longer term use will be efficacious. Dr Gerson, We are much more restrictive in our use of Indocin. This is a result of the work of Drs' van der Heijden et al, Dr Norton and Dr. Major. van der Heijden described 6 neonatal anuric deaths after 2-11 week of indomethacin exposure over a 6 year interval. Norton demonstrated significant increases in neonatal NEC, IVH and PDA in less than 30 week indomethacin exposed neonates. Major described an increased incidence of NEC in indomethacin exposed infants vs. controls when used for longer than 48 hours. While I agree that it works and is cost effective, it is the fetal side effects which has limited our use of indomethacin to a 48 hour window below 32 weeks, exactly as outlined by Dr. Moise. van der Heijden BJ et al. Am J Obstet Gynecol 1994;171:617-23 Major CA, et al. Am J Obstet Gynecol 1994;170:102-6 Norton ME et al. New England J Med 1993;329:1602-7 IRA
-- Ira M. Bernstein M.D. Department of OB\GYN University of Vermont (802) 656-5111 (ph) ibernste@moose.uvm.edu
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