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Updated: May 26, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Prophylactic indomethacin infusion increases fractional cerebral oxygen extraction in ELBW neonates
R S Garner1, C Miller, D J Burchfield
1Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL 32610-0296, USA.
Insights
Indomethacin administration in extremely low birth weight neonates increased cerebral oxygen extraction by 9%. This finding suggests potentially harmful decreased cerebral perfusion in the developing brain.
Area of Science:
- Neonatal medicine
- Pediatric neurology
- Medical physiology
Background:
- Intraventricular hemorrhage (IVH) affects up to 25% of very low birth weight (VLBW) preterm neonates.
- Indomethacin prophylaxis reduces severe IVH but may decrease cerebral blood flow and oxygen delivery.
- Near-infrared spectroscopy (NIRS) can monitor cerebral oxygenation in neonates.
Purpose of the Study:
- To determine if indomethacin administration decreases cerebral oxygen saturation and increases cerebral oxygen extraction in extremely low birth weight (ELBW) neonates.
- To assess the impact of slow indomethacin infusion on cerebral oxygenation using NIRS.
Main Methods:
- Twenty-seven ELBW neonates (<30 weeks gestational age) received indomethacin for IVH prophylaxis.
- Cerebral oxygenation was monitored using NIRS, measuring regional cerebral oxygen saturation (rSO(2)).
- Arterial oxygen saturation (SaO(2)) and mean arterial pressure (MAP) were recorded; fractional cerebral oxygen extraction was calculated before, during, and after indomethacin infusion.
Main Results:
- Fractional cerebral oxygen extraction increased significantly from baseline (0.23±0.11) to 0.25±0.10 after indomethacin administration (P=0.034).
- This represents a 9% increase in fractional cerebral oxygen extraction.
Conclusions:
- Indomethacin administration over 1-2 hours resulted in a 9% increase in fractional cerebral oxygen extraction in ELBW neonates.
- The clinical significance of this increased extraction, potentially indicating reduced cerebral perfusion, remains unknown but warrants caution due to potential harm to the developing brain.
Objective:
Intraventricular hemorrhage (IVH) occurs in up to 25% of very low birth weight (VLBW) preterm neonates. Previous studies found that indomethacin administered in the first 6 h of life reduces the incidence of severe IVH in VLBW neonates and decreases cerebral blood flow, suggesting a decrease in cerebral oxygen delivery. Using near-infrared spectroscopy (NIRS), we monitored cerebral oxygenation before, during and after slow indomethacin infusion in extremely low birth weight (ELBW) neonates to determine whether indomethacin decreases cerebral oxygen saturation and increases cerebral oxygen extraction.
Study Design:
Twenty-seven ELBW neonates less than 30 weeks gestational age treated with indomethacin for IVH prophylaxis were monitored for arterial oxygen saturation (SaO(2)) and NIRS-determined regional cerebral oxygen saturation (rSO(2)). At 30 to 60 s intervals, SaO(2), rSO(2) and mean arterial pressure (MAP) were recorded using a VitalSync. Average fractional cerebral oxygen extraction was calculated for the hour before indomethacin infusion, during the infusion and 2 h after infusion.
Result:
Fractional cerebral oxygen extraction increased from baseline after indomethacin administration from 0.23±0.11 to 0.25±0.10 (P=0.034).
Conclusion:
Fractional cerebral oxygen extraction increased 9% with indomethacin 0.1 mg kg(-1) given over 1 to 2 h. However, the clinical implications of this small increase in extraction, likely representative of decreased cerebral perfusion, are unknown but may be harmful to the developing brain.
