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Published on: November 20, 2015
Indomethacin tocolysis and white matter injury in preterm infants
S Friedman1, O Flidel-Rimon, M Steinberg
1Department of Neonatology, Kaplan Medical Center, Rehovot, Israel.
Insights
Indomethacin tocolysis in preterm infants is linked to white matter injury, specifically periventricular echogenicity. Caution is advised when using indomethacin for tocolysis due to potential neonatal risks.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Neuroscience
Background:
- Preterm birth complications pose significant risks to neonatal neurodevelopment.
- White matter injury (WMI) is a major concern in preterm infants, impacting long-term outcomes.
- Tocolytic agents are used to prolong gestation but may have associated neonatal effects.
Purpose of the Study:
- To investigate the association between indomethacin tocolysis and neonatal white matter injury (WMI) in preterm infants.
- To determine if indomethacin use correlates with specific types of WMI detected by cranial ultrasound.
- To clarify the risks of indomethacin in the context of neonatal brain development.
Main Methods:
- Retrospective review of preterm infants (24-32 weeks gestation).
- Cranial ultrasound examinations (CUS) were used to assess for WMI.
- Infants with normal CUS were compared to those with WMI using univariate and multivariate analyses.
Main Results:
- Indomethacin tocolysis showed a significant correlation with periventricular echogenicity (PVE) (OR 2.84, p = 0.003).
- No significant correlation was found between indomethacin and periventricular leucomalacia (PVL) (OR 1.83, p = 0.29).
- Indomethacin was not associated with increased risk of periventricular-intraventricular hemorrhage or hemorrhagic infarction.
Conclusions:
- Indomethacin tocolysis is associated with an increased risk of periventricular echogenicity in preterm infants.
- Findings suggest a need for caution when administering indomethacin as a tocolytic therapy.
- Further research may explore alternative tocolytic strategies to mitigate neonatal WMI risks.
Objective:
This study aims to clarify the relationship between indomethacin tocolysis and neonatal white matter injury (WMI) in preterm infants.
Methods:
We conducted a retrospective review of preterm infants born at 24-32 weeks who had sufficient cranial ultrasound examinations (CUS) to determine the incidence and severity of abnormalities. Infants with normal CUS were compared on univariate and multivariate analyses with infants with the different forms of WMI.
Results:
On multivariate logistic regression analysis, indomethacin tocolysis was significantly correlated with periventricular echogenicity (PVE; OR 2.84 95% CI 1.41-5.7, p = 0.003), but not with periventricular leucomalacia (PVL; OR 1.83 95% CI0.6-5.6, p = 0.29). Indomethacin was not related to increased risk for periventricular-intraventricular hemorrhage or periventricular hemorrhagic infarction.
Conclusion:
These findings suggest caution in the use of indomethacin as a tocolytic therapy.