Outcomes following indomethacin prophylaxis in extremely preterm infants in an all-referral NICU

Nelin, Timothy D.; Pena, E; Giacomazzi, T; Lee, S; Logan, John W.; Moallem, Mohannad; Bapat, Roopali; Shepherd, Edward G.; Nelin, Leif D.

doi:10.1038/jp.2017.71

Cited by 20 publications

(13 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the USA, many centers use indomethacin as a drug to prevent (severe) intraventricular hemorrhage (IVH) (53), although this is not a property of paracetamol. A study has shown that prophylactic indomethacin administration given in extremely premature infants at level 4 neonatal intensive care units (NICUs) could improve survival but had no significant effect on the incidence of severe IVH or PDA closure (54). Therefore, the current evidences make it difficult to distinguish which of the two drugs is the best.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Xiao

Liu

et al. 2020

Front. Pediatr.

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Xiao

Liu

et al. 2020

Front. Pediatr.

View full text Add to dashboard Cite

“…The incidence of severe IVH is significantly decreased by targeted administration of indomethacin to neonates born at <29 weeks, who were not exposed to or who had received a partial course of antenatal steroids (30). Recently, prophylactic indomethacin was associated with improved survival in an out-born cohort of extremely preterm infants who were referred to a Level IV NICU (31). Of note, there was no statistical difference in survival in our cohort of neonates who had a PDA treated with early indomethacin.…”

Section: Discussionmentioning

confidence: 99%

Intraventricular Hemorrhage: Risk Factors and Association With Patent Ductus Arteriosus Treatment in Extremely Preterm Neonates

et al. 2019

View full text Add to dashboard Cite

Objectives: To assess maternal and neonatal risk factors for intraventricular hemorrhage (IVH). To examine the association of patent ductus arteriosus (PDA) and its treatment, with IVH and its severity.Study design: In this retrospective cohort study, we included preterm neonates born at <29 weeks, admitted to a tertiary level III Neonatal Intensive Care Unit in Calgary, Canada, between 2013 and 2016, who had a head ultrasound in the first 7 days of life. A subset analysis included neonates who also had cardiac ultrasound in the first 3 days of life.Results: Of the 495 neonates, 121 (24.4%) had IVH of any grade and 48 (9.7%) had severe IVH. Identified risk factors were small birth gestation and weight, lack of antenatal corticosteroids, maternal chorioamnionitis, Apgar score <5 at 5 min, umbilical cord pH < 7, respiratory distress syndrome, early onset sepsis, hypercapnia, pCO2 fluctuations, prolonged intubation, inhaled nitric oxide, inotropes or normal saline boluses, metabolic derangements, opioids infusions, and bicarbonate/THAM therapy. In a primary analysis of the total cohort, when the decision to treat a PDA was used as a surrogate marker of its clinical significance, a PDA requiring treatment was associated with a higher risk of IVH. There was no significant difference in the incidence of IVH between neonates with early treatment of a clinically significant PDA compared to late, however early indomethacin treatment was associated with reduced severity of IVH. In the subset analysis, the presence of a hemodynamically significant PDA (hs-PDA) was not associated with a higher probability of IVH. Of those with severe IVH, 18 (55%) had a hs-PDA; this is clinically but not statistically significant.Conclusions: Identified risk factors should be the target of IVH reduction bundles. Early indomethacin treatment for a clinically significant PDA may reduce IVH severity.

show abstract

“…We have found that the use of prophylactic indomethacin in babies admitted to the Small Baby Program was associated with a substantial improvement in survival (Fig. 3), with a relative risk reduction of 48% and a number needed to treat of only 7 [17]. Indeed, when we evaluate factors associated with mortality in patients admitted to the small baby program, the use of prophylactic indomethacin is one of the predictors of survival [18].…”

Section: Discussionmentioning

confidence: 96%

Development of a small baby unit to improve outcomes for the extremely premature infant

et al. 2021

View full text Add to dashboard Cite

Survival and outcomes for extremely premature (EP) infants have improved and even infants born at 23 and 24 weeks that were previously considered non-viable are now routinely surviving. This review describes our particular institution's basis for and process of creating and sustaining a small baby program for a quaternary, referral-based neonatal intensive care unit. Through multidisciplinary collaboration, small baby guidelines were developed that established uniform care and optimized evidence-based practice for the care of this unique patient population. A focus on parent-centered care while removing noxious stimuli for the patient has improved neurodevelopmental outcomes. Data collection, quality improvement, and ongoing research are incorporated in the small baby program to establish and sustain best practices and outcomes for the EP patient. Through the establishment of a small baby unit, we have improved survival, decreased short-term morbidities, and improved neurodevelopmental outcomes for the EP infant in our region.

show abstract

Outcomes following indomethacin prophylaxis in extremely preterm infants in an all-referral NICU

Abstract: PI administration was associated with improved survival in EP infants referred to a level IV Children's Hospital NICU.

Cited by 20 publications

References 29 publications

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Efficacy and Safety of Paracetamol for Patent Ductus Arteriosus Closure in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Intraventricular Hemorrhage: Risk Factors and Association With Patent Ductus Arteriosus Treatment in Extremely Preterm Neonates

Development of a small baby unit to improve outcomes for the extremely premature infant

Contact Info

Product

Resources

About