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Prophylactic indomethacin in extremely premature infants between 23 and 24 weeks gestation
Seiji Yoshimoto1, Hitomi Sakai, Masaaki Ueda
1Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Japan. yoshimoto_kch@hp.pref.hyogo.jp
Insights
Prophylactic indomethacin (INDO) in extremely premature infants significantly reduced symptomatic patent ductus arteriosus (PDA) without increasing adverse effects. This approach offers a safe strategy for managing PDA in this vulnerable population.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) in extremely premature infants (<25 weeks gestation) increases risks of severe morbidities.
- Conservative management for PDA closure is often ineffective (<20% success rate).
Purpose of the Study:
- To evaluate the efficacy and safety of prophylactic indomethacin (INDO) for PDA closure.
- To assess INDO's impact on symptomatic PDA in infants born at 23-24 weeks gestation.
Main Methods:
- Historical case-control study involving 30 infants (23-24 weeks gestation).
- Prophylactic INDO group received a continuous 12-hour infusion within 6 hours of birth.
- Control group received INDO only for symptomatic PDA.
Main Results:
- No infants in the prophylactic INDO group developed symptomatic PDA.
- 11 of 15 infants (73%) in the control group had symptomatic PDA (P < 0.001).
- No significant differences in mortality or early neonatal morbidity between groups.
Conclusions:
- Prophylactic INDO administration effectively decreases symptomatic PDA incidence in extremely premature infants.
- This prophylactic strategy appears safe, without increasing adverse effects compared to treatment of symptomatic PDA.
Background:
In extremely premature infants, the presence of a left-to-right shunt through a patent ductus arteriosus (PDA) increases the risks of pulmonary hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, renal failure, and chronic lung disease. Conservative management induces spontaneous ductus closure in <20% of extremely premature infants (infants born at <25 weeks of gestation). The aim of the present study was to determine the efficacy and safety of prophylactic indomethacin (INDO) administration for PDA closure in extremely premature infants born between 23 and 24 weeks of gestation.
Methods:
A historical case-control study of 30 infants born between 23 and 24 weeks of gestation was carried out. In the prophylactic INDO group, a 12 h-long, 0.01 mg/kg per h dose of INDO was administered within 6 h of life. During the historical control period, only infants with symptomatic PDA were treated with INDO for 1 h. The incidence of symptomatic PDA, mortality and early neonatal morbidity was compared between the two groups on Fisher's exact test and Mann-Whitney rank-sum test.
Results:
None of the infants in the prophylactic INDO group had symptomatic PDA, while 11 of the 15 infants in the control group showed symptomatic PDA (P < 0.001). There were no significant differences between the mortality rates and the early neonatal morbidities in the two groups.
Conclusions:
Prophylactic INDO administration to extremely premature infants born between 23 and 24 weeks of gestation decreased the incidence of symptomatic PDA without increasing the incidence of adverse effects.
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