Drug-induced decreased urine output predicts PDA closure in preterm neonates

ABSTRACT Objective Prostaglandin inhibitors (PGI) are used to treat patent ductus arteriosus (PDA) of prematurity. PGIs often cause decrease in urine output (UO), the mechanism of which is like that of PDA closure. We hypothesized that PGI-induced decrease in UO predicts PDA closure. Design Prospective, cohort Setting Level III NICU Methods We prospectively enrolled 40 preterm neonates (≤34 weeks gestation) with clinical and/or echocardiographic hemodynamically significant PDA (hsPDA), being treated with Ibuprofen or Paracetamol. We measured UO, weight, total fluid intake (TFI) at baseline and daily until 72 h. We performed echocardiogram at baseline and daily until PDA closure or end of treatment. We compared “PDA-closed” and “PDA-open” groups for change in UO, weight and TFI from baseline. Results “PDA-closed” and “PDA-open” groups had 28 and 12 neonates respectively. Median (Q1, Q3) percent decrease in UO was greater in “PDA-closed” vs “PDA-open” group: from baseline to 0-24 h [-44.87% (−54.79%, +0.04%) vs −15.03% (−27.91%, +49.11%)]; to 24-48 hours [-40.85% (−52.81%, +14.45%) vs. −2.57% (−24.82%, +61.73%) and to 48-72 hours [-32.77% (−49.4%, +32.22%) vs. +20.74% (−6.88%, +98.39%). “PDA closed” group had significantly greater percent decrease in weight by 72-h. Mixed linear model showed that “group” and “time” were independently associated with UO; but “group*time” interaction and covariates (echocardiographic hsPDA, weight, gestation, postnatal age) were not. Decrease in UO of 27% and 17% by 24-48 h and 48-72 h respectively, best predicted PDA closure. Conclusions Transient decrease in UO after treating hsPDA with a PGI may predict successful closure of PDA.