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Prophylactic indomethacin for preterm infants: a systematic review and meta-analysis
1Department of Child Health University of Dundee and Tayside University Hospital Trust, Dundee, Scotland, UK.
Archives of Disease in Childhood. Fetal and Neonatal Edition
|November 7, 2003
Summary
Prophylactic indomethacin reduces short-term complications like intraventricular hemorrhage in preterm infants. However, this treatment does not improve long-term survival rates free of disability.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Pharmacology
Background:
- Preterm birth leads to high rates of long-term infant morbidity.
- Prophylactic indomethacin can reduce intraventricular hemorrhage but may cause adverse effects due to reduced organ perfusion.
Purpose of the Study:
- To evaluate the impact of prophylactic indomethacin on mortality and short-term and long-term morbidity in preterm infants.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials was conducted.
- Searches included Medline, Cochrane Controlled Trials Register, and conference abstracts (1966-2002).
- Trials involving intravenous indomethacin within 24 hours of birth were analyzed for prespecified outcomes.
Main Results:
- Nineteen trials were identified; four reported long-term outcomes.
- Indomethacin significantly reduced severe intraventricular hemorrhage (RR 0.66) and patent ductus arteriosus requiring surgery (RR 0.51).
- No significant differences were found in long-term death or severe neurosensory impairment (RR 1.02).
Conclusions:
- Prophylactic indomethacin offers short-term benefits for preterm infants.
- There is no evidence that indomethacin improves long-term survival free of disability.