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COX-2 inhibitors may not be safe for tocolysis The potent effects of indomethacin as a tocolytic are well known, and it has recently been suggested that nimesulide, a selective COX-2 inhibitor, might be even better. However, animal experiments have now supported postulates of impaired foetal and neonatal renal haemodynamics following case reports of foetal and neonatal renal insufficiency and failure. In the foetus and neonate (and particularly the preterm neonate) the kidney has a low GFR which is controlled by a delicate balance of intrarenal vasoconstrictor and vasodilator forces. This balance is susceptible to factors which might interfere with renal haemodynamics. The main causes for acute renal failure at this stage are prerenal including hypotension, hypovolaemia, perinatal asphyxia, septicemia, and administration of drugs such as ACE inhibitors or receptor antagonists, NSAIDS such as indomethacin, and tolazoline. Apparently selective COX-2 inhibitors should be considered for inclusion on this list as one of the offending NSAIDS. Read more: Pediatr Res 2003 Nov 6 Epub on PubMed Ped Nephrol 2003 Nov 25 Epub on PubMed J Perinatol 2003;23:254-5 J Perinatol 2002;22:541-6 Ped Nephrol 2000;14:227-39 |