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Recent indomethacin tocolysis is not associated with neonatal complications in preterm infants
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425, USA.
Objective:
We sought to determine whether indomethacin tocolysis immediately before delivery is associated with any increased complications in neonates delivered between 24 and 32 weeks' gestation.
Study Design:
We performed a case-control analysis of neonates delivered between 24 and 32 weeks' gestation after maternal indomethacin treatment for preterm labor. All infants were delivered within 48 hours of indomethacin exposure. Seventy-five patients were matched with 150 control subjects in a patient/control ratio of 1:2. Matching variables in order of priority included gestational age at delivery, fetal number, betamethasone exposure >24 hours before delivery, magnesium sulfate use, mode of delivery, infant sex, and race. Data were analyzed by using the Student t test, chi(2) analysis, and the Fisher exact test and Yates' correction.
Results:
The gestational age at delivery (mean +/- SD) was 28.7 +/- 2.3 weeks in the indomethacin group and 28.3 +/- 2.1 weeks for the control subjects. Birth weights (mean +/- SD) were 1121 +/- 243 and 1141 +/- 287 g, respectively. All mothers received both magnesium sulfate and betamethasone before delivery. The median cumulative dose of indomethacin was 225 mg. The median interval from last dose of indomethacin until delivery was 12 hours. There were no significant differences between the groups in the incidence of necrotizing enterocolitis (odds ratio, 1.12; 95% confidence interval, 0.31-3.84), grade III/IV intraventricular hemorrhage (odds ratio, 0.37; 95% confidence interval, 0.10-1.19), patent ductus arteriosus (odds ratio, 0.85; 95% confidence interval, 0.44-1.64), bronchopulmonary dysplasia (odds ratio, 0.97; 95% confidence interval, 0.49-1.91), pulmonary hypertension (odds ratio, 0.49; 95% confidence interval, 0. 02-4.80), anuria (odds ration, 1.21; 95% confidence interval, 0.22-6. 01), thrombocytopenia (odds ratio, 1.14; 95% confidence interval, 0. 53-2.42), sepsis (odds ratio, 1.21; 95% confidence interval, 0.22-6. 01), or neonatal death (odds ratio, 1.34; 95% confidence interval, 0. 55-3.25).
Conclusion:
Maternal indomethacin exposure immediately before delivery was not associated with increased neonatal complications for infants delivered between 24 and 32 weeks' gestation.