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Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants
John Kelleher1, Ariel A Salas1, Ramachandra Bhat1
1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;
Insights
Prophylactic indomethacin and early feeding do not increase spontaneous intestinal perforation (SIP) risk in extremely low birth weight (ELBW) infants. These therapies, when used together or alone, were found to be safe for ELBW infants, reducing SIP risk.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Clinical Pharmacology
Background:
- Prophylactic indomethacin reduces severe intraventricular hemorrhage in extremely low birth weight (ELBW) infants but may increase spontaneous intestinal perforation (SIP) risk.
- Early feeding in ELBW infants improves nutritional outcomes but also carries a potential risk of SIP.
- Physician preferences largely dictate the use of these therapies due to concerns about SIP.
Purpose of the Study:
- To evaluate the association between prophylactic indomethacin, early feeding, and the risk of spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants.
- To determine if the combined or individual use of these interventions impacts SIP risk.
- To inform clinical practice regarding the use of indomethacin and early feeding in ELBW infants.
Main Methods:
- A cohort study of 15,751 ELBW infants was conducted.
- Data were collected from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (1999-2010).
- Risk of SIP was compared between infants with and without exposure to prophylactic indomethacin and early feeding, with adjusted analyses.
Main Results:
- Among infants receiving prophylactic indomethacin, the risk of SIP did not differ between those also receiving early feeding versus those not (adjusted RR 0.74).
- The indomethacin/early-feeding group had a lower risk of SIP compared to the no indomethacin/no-early-feeding group (adjusted RR 0.58).
- Among infants not receiving indomethacin, early feeding was associated with a lower risk of SIP (adjusted RR 0.53).
Conclusions:
- Neither prophylactic indomethacin nor early feeding, individually or combined, was associated with an increased risk of spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants.
- The findings suggest that these therapies can be used safely in ELBW infants.
- Clinical use of prophylactic indomethacin and early feeding may be considered without increased concern for SIP.
Objective:
Prophylactic indomethacin reduces severe intraventricular hemorrhage but may increase spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants. Early feedings improve nutritional outcomes but may increase the risk of SIP. Despite their benefits, use of these therapies varies largely by physician preferences in part because of the concern for SIP.
Methods:
This was a cohort study of 15,751 ELBW infants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 1999 to 2010 who survived beyond 12 hours after birth. The risk of SIP was compared between groups of infants with and without exposure to prophylactic indomethacin and early feeding in unadjusted analyses and in analyses adjusted for center and for risks of SIP.
Results:
Among infants exposed to prophylactic indomethacin, the risk of SIP did not differ between the indomethacin/early-feeding group compared with the indomethacin/no-early-feeding group (adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.49-1.11). The risk of SIP was lower in the indomethacin/early-feeding group compared with the no indomethacin/no-early-feeding group (adjusted RR 0.58, 95% CI 0.37-0.90, P = .0159). Among infants not exposed to indomethacin, early feeding was associated with a lower risk of SIP compared with the no early feeding group (adjusted RR 0.53, 95% CI 0.36-0.777, P = .0011).
Conclusions:
The combined or individual use of prophylactic indomethacin and early feeding was not associated with an increased risk of SIP in ELBW infants.
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