The incidence of renal calcification in preterm infants

Article Abstract:

Although survival of premature infants has improved, the care of these infants is complicated by various problems. Premature infants have an increased risk for developing calcium salt depositions in the kidneys (renal calcification). Renal calcification may be associated with hypercalciuria (increased levels of calcium in the urine) and treatment with furosemide (a diuretic). The recognition of this problem has improved with the use of ultrasound, in which sound waves are used to visualize internal images. A recent study reported the incidence of renal calcification in infants with birth weights of less than 1,500 grams to be 64 percent. In this study, renal calcification occurred in the absence of furosemide treatment. Impaired kidney function, parenteral feeding (in which nutrients are administered intravenously), lack of movement over a long duration, and the loss of bone mineral content may contribute to the development of renal calcification. The incidence of renal calcification and predisposing factors were assessed in 79 infants born at less than 32 weeks' gestation. Renal calcification was diagnosed in 21 infants (26.6 percent). The infants who developed this disorder tended to be smaller and less mature than infants without renal calcification. Ultrasound revealed hyperechogenic renal pyramids, or images of cone-like structures in the kidney, in 17 patients, and kidney stones in four patients. Renal calcification was associated with low blood phosphate levels, abnormally increased blood calcium and creatinine levels, and a persistent need for oxygen treatment during the first month of life. The most significant factor associated with the development of renal calcification was duration of oxygen treatment. Infants who still needed oxygen support at 28 days had a 62 percent chance of developing renal calcification. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Risk factors, Infants (Premature), Premature infants, Kidneys, Premature birth, Kidney, Calcification

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Prolonged low dose indomethacin for persistent ductus arteriosus of prematurity

Article Abstract:

Indomethacin is a drug whose major effects in the body are associated with the ability to decrease synthesis of prostaglandins, locally produced and locally acting hormones which modulate a variety of tissue functions. Indomethacin is helpful in diminishing abnormal blood flow in newborns caused by persistence of a fetal blood vessel, the ductus arteriosus, which normally closes at birth. Success rates with the drug are 60 to 80 percent, but up to 30 percent of patients may relapse. Many questions have been raised as to whether preventive use of the drug is justified, particularly in low-birth-weight infants, and regarding how to increase the drug's effectiveness. High doses of indomethacin are associated with gastrointestinal bleeding, and other studies suggest that discontinuation of short-term treatment is associated with new prostaglandin synthesis. The effectiveness of prolonged (for six days) low-dose indomethacin therapy was compared with that of short-term (for 36 hours) higher-dose treatment in 121 infants. Fifty-three of 59 infants responded to low-dose therapy, while 48 of 62 given higher doses responded. Twenty-one percent of the low-dose responders and 40 percent of the high-dose responders relapsed, a significant difference. A similar incidence of side effects, mostly gastrointestinal bleeding, was observed in both groups. There were significantly more deaths in the low-dose group, but none could be directly attributed to the drug therapy. The results suggest that prolonged low-dose therapy with indomethacin is more effective and results in a lower relapse rate of persistent ductus arteriosus than high-dose indomethacin. Further study of effectiveness and side effects are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Patent ductus arteriosus

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Acute asthma attack due to ophthalmic indomethacin

Article Abstract:

Studies have shown that asthma can be worsened by timolol, a drug used to treat eye disorders. A case is described of a 79-year-old woman with long-standing asthma who received another eye medication, indomethacin eye drops, and developed a life-threatening respiratory attack. She had been using the eye drops for four weeks when the asthma attack occurred. The patient was admitted to the hospital with difficulty breathing, cough, and pus-containing sputum or throat secretions. She had severe respiratory distress with signs of bronchospasm, constriction of the airways accompanied by coughing and wheezing. The patient was eventually placed on a ventilator and given anti-asthmatic agents. Although she improved and was removed from the ventilator, the administration of indomethacin eye drops precipitated another attack of severe respiratory distress and bronchospasm, that was later complicated by pneumonia. The patient was again placed on a ventilator and given anti-asthmatic agents. She gradually improved and was discharged six weeks after admission in stable condition. Studies have shown that various dosage forms of indomethacin, including those given by mouth, directly into the circulation, or as a suppository, may worsen asthma and even cause respiratory arrest and death. However, there have been no reports that indomethacin given in the form of eye drops worsens asthma. These findings show that before indomethacin eye drops are prescribed, the physician should carefully evaluate the patient for history of asthma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Asthma

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