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Case Report

Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant

1
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 704302, Taiwan
2
Department of Pediatrics, Tainan Hospital, Ministry of Health and Welfare, Tainan 700007, Taiwan
3
Department of Surgery, Tainan Sinlau Hospital, Tainan 701002, Taiwan
4
Department of Surgery, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan
5
Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Sari A. Acra
Children 2021, 8(7), 545; https://doi.org/10.3390/children8070545
Received: 25 May 2021 / Revised: 3 June 2021 / Accepted: 21 June 2021 / Published: 24 June 2021
(This article belongs to the Special Issue Abdominal Surgery in Pediatrics)
Indomethacin has been widely used in preterm infants with hemodynamically significant patent ductus arteriosus (PDA). Gastrointestinal complications of indomethacin have been reported in 5% of treated neonates. However, massive gastric mucosa hemorrhage is a rarely reported complication. To the best of our knowledge, the infant in this report is the smallest reported in the literature to have undergone successful surgery for such a complication. A male preterm infant weighing 566 g was born at 252/7 weeks of gestational age without a complicated maternal history. Soon after birth, he received nasal noninvasive respiratory support and minimal feeding. PDA was observed since the first day of life (DOL), treatments were initiated on the second DOL for the hemodynamical significance, and PDA was closed after two courses of indomethacin therapy (0.2 mg/kg). At midnight on the seventh DOL, generalized pallor, bloody gastric drainage, and a distended stomach were observed. Massive gastric bleeding was suspected. He suffered from intermittent hypotension, which was corrected with blood products and fluid resuscitation under monitoring with a radial arterial line. Gastric lavage with cooling saline was performed twice but in vain. Prior to surgical consultation, intravascular volume transfusion was given twice. An exploratory laparotomy was arranged after obtaining the parents’ consent. Blood oozing from the gastric mucosa was observed through gastrostomy and was successfully stopped via epinephrine-soaked gauze compression. After the operation, his clinical course remained uneventful, and he was discharged without neurological anomaly at two-year follow-up. Physicians need to be cautious of indomethacin’s effect on platelet dysfunction in preterm infants with multiple predisposing factors. The tendency for mucosal bleeding should be continuously monitored after indomethacin therapy. View Full-Text
Keywords: indomethacin; hemorrhage; preterm infants; surgery; gastric bleeding; coagulopathy; ductus arteriosus indomethacin; hemorrhage; preterm infants; surgery; gastric bleeding; coagulopathy; ductus arteriosus
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MDPI and ACS Style

Chen, Y.-J.; Chu, W.-Y.; Yu, W.-H.; Chen, C.-J.; Chia, S.-T.; Wang, J.-N.; Lin, Y.-C.; Wei, Y.-J. Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant. Children 2021, 8, 545. https://doi.org/10.3390/children8070545

AMA Style

Chen Y-J, Chu W-Y, Yu W-H, Chen C-J, Chia S-T, Wang J-N, Lin Y-C, Wei Y-J. Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant. Children. 2021; 8(7):545. https://doi.org/10.3390/children8070545

Chicago/Turabian Style

Chen, Yen-Ju, Wei-Ying Chu, Wen-Hao Yu, Chau-Jing Chen, Shu-Ti Chia, Jieh-Neng Wang, Yung-Chieh Lin, and Yu-Jen Wei. 2021. "Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant" Children 8, no. 7: 545. https://doi.org/10.3390/children8070545

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