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Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants

Peter W Fowlie1, Peter G Davis, William McGuire

  • 1Women & Child Health, Ninewells Hospital and Medical School, Dundee, Scotland, UK, DD1 9SY.

The Cochrane Database of Systematic Reviews
|July 9, 2010
PubMed

Insights

Prophylactic indomethacin reduces symptomatic patent ductus arteriosus (PDA) and intraventricular hemorrhage in preterm infants. However, this treatment does not impact mortality or long-term neurodevelopmental outcomes.

Area of Science:

  • Neonatal medicine
  • Pharmacology
  • Clinical trials

Background:

  • Persistent patent ductus arteriosus (PDA) is a common complication in preterm infants, linked to increased mortality and morbidity.
  • Indomethacin, a prostaglandin synthetase inhibitor, can close PDA but carries potential side effects.
  • The prophylactic use of indomethacin in preterm infants warrants careful evaluation due to potential risks.

Purpose of the Study:

  • To assess the efficacy and safety of prophylactic indomethacin administration in preterm infants.
  • To determine the impact of prophylactic indomethacin on PDA-related outcomes and overall mortality.
  • To evaluate the effect of prophylactic indomethacin on neurodevelopmental outcomes in preterm infants.

Main Methods:

  • A systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
  • Searches conducted across major databases including CENTRAL, MEDLINE, EMBASE, and CINAHL.
  • Nineteen trials involving 2872 preterm infants were analyzed for outcomes.

Main Results:

  • Prophylactic indomethacin significantly reduced the incidence of symptomatic PDA and the need for surgical ligation.
  • A significant decrease in severe intraventricular hemorrhage was observed in infants receiving prophylactic indomethacin.
  • No significant effect was found on mortality or a composite of death or severe neurodevelopmental disability.

Conclusions:

  • Prophylactic indomethacin offers short-term benefits by reducing PDA and severe intraventricular hemorrhage in preterm infants.
  • Current evidence does not support a reduction in mortality or improvement in neurodevelopmental outcomes with prophylactic indomethacin.
  • Further research may be needed to balance the short-term benefits against potential long-term risks.
Abstract

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