Effects of Prophylactic Indomethacin in Extremely Low-Birth-Weight Infants With and Without Adequate Exposure to Antenatal Corticosteroids

Abstract

To examine whether treatment with antenatal corticosteroids modifies the immediate and longterm effects of prophylactic indomethacin sodium trihydrate in extremely low-birth-weight infants.Design: Post hoc subgroup analysis of data from the Trial of Indomethacin Prophylaxis in Preterms.

Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants

“…17,18 Similar to our findings, TIPP investigators found no difference in the risk of death with prophylactic indomethacin compared with placebo based on a full course versus partial course or no treatment with antenatal corticosteroids. 18 TIPP also found a possible subgroup effect for mortality by sex (interaction p-value = 0.054). 17 However, in contrast to our results, the risk of death was increased for females who were treated with prophylactic indomethacin compared with placebo and was no different for males.…”

Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room

“…In 49 infants, no difference in IVH was reported; however, the targeted V T was between 4 and 8 mL/kg 7 , which is considerably higher compared with the cut-off in the current study. Indomethacin has been shown to reduce severe IVH,50 and the percentage of indomethacin prophylaxis was similar in our study and therefore not the cause for the increased rate of IVH.…”

Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation

“…3,4,36 Independently, antenatal steroids and prophylactic indomethacin have been shown to reduce the incidence of severe IVH in several randomized trials and observational studies. 3,4,29,36,37 An expected protective effect of the combination of antenatal steroids and prophylactic indomethacin against severe IVH (by increasing stability of the cerebral vasculature and micro vessel maturation in the germinal matrix) was not demonstrated in our study, in any of the steroid groups, either with or without prophylactic indomethacin. Our findings may be due to the inclusion of only infants with the highest risk of IVH (eg, those born at <26 weeks of gestation or <750 g birth weight), which is a different population from those examined in previous studies.…”