Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants

Fowlie, Peter W; Davis, Peter G; McGuire, William

doi:10.1002/14651858.cd000174.pub2

Cited by 308 publications

(263 citation statements)

References 72 publications

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“…Prophylactic indomethacin may have short-term benefits for preterm infants including a reduction in the incidence of symptomatic PDA, PDA surgical ligation, and severe IVH [14]. From 2006, we routinely introduced indomethacin prophylaxis for preterm infants born at <25 weeks of GA to reduce the risk of intraventricular hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Survival and Neurodevelopmental Outcome of Preterm Infants Born at 22-24 Weeks of Gestational Age

et al. 2013

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Background: The limits of viability in extremely premature infants are challenging for any neonatologists in developed countries. The neurological development and growth of extremely preterm infants have come to be the emerging issue following the management in the neonatal intensive care unit. Objective: To assess potential associations between changes in practice and survival/neurodevelopmental outcome, and clinical outcomes of extremely preterm infants born at the limit of viability studied in a tertiary center. Study Design: A retrospective study enrolled 51 infants who had no congenital disorders, and were born at 22-24 weeks of gestational age (GA) in 2000-2009 in our institution. Clinical variables and interventions were studied with regard to one-year survival and developmental quotient (DQ) at 3 years of age. Results: The one-year survival rate of 24 preterm infants born in 2005-2009 (79%) was higher than that of the 27 infants born in 2000-2004 (52%, p = 0.04). Infants born after 2005 underwent less tocolysis (54 vs. 94%, p < 0.01) and more frequently antenatal steroid therapy (32 vs. 6%, p = 0.01) than those born before 2004. The post-2005 survivors (n = 19) received more frequently indomethacin therapy (89 vs. 50%, p = 0.03) and early parenteral nutrition (95 vs. 36%, p < 0.01) than the pre-2004 survivors (n = 14). There were no differences in the proportion of infants who attained a DQ of >50 at 3 years of age between pre-2004 (9/13, 69%) and post-2005 groups (10/17, 59%). Multivariate analysis indicated that extremely premature birth at GA <24 weeks was the sole critical factor for a DQ of >50 in survivors. Conclusions: The perinatal care after 2005 improved the overall survival rate, but not the neurological outcome of preterm survivors at the limit of viability. Neurodevelopmental impairments were associated with extremely premature birth at GA <24 weeks.

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Section: Discussionmentioning

confidence: 99%

Survival and Neurodevelopmental Outcome of Preterm Infants Born at 22-24 Weeks of Gestational Age

et al. 2013

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“…For indomethacin most studies have used 0.1 mg/kg/d for three doses. Meta-analysis results of prophylactic indomethacin use showed 50 % reduction of hsPDA, 35 % reduction in severe IVH (> grade2), and 50 % reduction in the need for surgical ligation of PDA, compared to placebo [32]. The trial of indomethacin prophylaxis in preterm infants (TIPP) also showed a reduction in early pulmonary hemorrhage.…”

Section: Prophylactic Therapymentioning

confidence: 98%

Management of Patent Ductus Arteriosus in Premature Infants

Bhat

Das

2014

Indian J Pediatr

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Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach.

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“…Antenatal corticosteroids are known to reduce the occurrence of patent ductus arteriosus and IVH. [41][42][43][55][56][57][58][59] Systematic reviews and meta-analyses of the studies of prophylactic postnatal indomethacin have confirmed the significant reduction in severe IVH. In 14 trials including over 2,500 newborns, a 35% reduction in severe IVH was evident (RR 0.66 [95% CI, 0.53-0.82], P,.001).…”

Section: The First Weekmentioning

confidence: 99%

“…In 14 trials including over 2,500 newborns, a 35% reduction in severe IVH was evident (RR 0.66 [95% CI, 0.53-0.82], P,.001). 58 However, a well-conducted study of prophylactic indomethacin did not show a benefit on neurodevelopmental outcomes, despite a reduction in severe IVH (Grades 3 and 4) from 13% to 9%. 59 The demonstrated reduction in severe IVH, serious pulmonary hemorrhage, and the need for surgical ligation of patent ductus arteriosus 59 may well be considered significant benefits by families.…”

Section: The First Weekmentioning

confidence: 99%

Periviable Birth

Raju

Mercer

Burchfield

et al. 2014

Obstetrics &Amp; Gynecology

129

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This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (eg, antenatal steroid, tocolytic agents, and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation, and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect, and understanding and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.

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Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants

Abstract: Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants.

Cited by 308 publications

References 72 publications

Survival and Neurodevelopmental Outcome of Preterm Infants Born at 22-24 Weeks of Gestational Age

Survival and Neurodevelopmental Outcome of Preterm Infants Born at 22-24 Weeks of Gestational Age

Management of Patent Ductus Arteriosus in Premature Infants

Periviable Birth

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