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Outcomes following indomethacin prophylaxis in extremely preterm infants in an all-referral NICU
T D Nelin1, E Pena2,3, T Giacomazzi2
1Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Prophylactic indomethacin (PI) administration in extremely premature (EP) infants transferred to a level IV NICU was associated with improved survival. This treatment did not significantly affect other outcomes like severe intraventricular hemorrhage or bronchopulmonary dysplasia.
Area of Science:
- Neonatal Intensive Care
- Pediatric Pharmacology
- Perinatal Medicine
Background:
- Extreme prematurity (EP) presents significant challenges in neonatal intensive care units (NICUs).
- The role of prophylactic indomethacin (PI) in improving outcomes for EP infants has been debated.
- Understanding the long-term benefits of PI in referred EP infants is crucial for clinical practice.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic indomethacin (PI) in extremely premature (EP) infants admitted to a level IV NICU.
- To determine if PI administration is associated with improved survival and other clinical outcomes in this specific cohort.
- To analyze the impact of PI on mortality and the combined outcome of death or bronchopulmonary dysplasia.
Main Methods:
- Observational study using the small baby ICU data registry (2005-2014).
- Inclusion of 671 extremely premature (EP) infants, with 530 receiving prophylactic indomethacin (PI) and 141 serving as controls.
- Analysis of infants transferred to a level IV NICU, with a mean admission age of 13 days, after the typical PI administration window.
Main Results:
- No significant differences in gestational age, birth weight, or severity of illness between PI and control groups.
- PI group showed a significantly lower mortality rate (RR 0.52, P=0.0001).
- PI was associated with a reduced risk of death or bronchopulmonary dysplasia (RR 0.91, P=0.012), but not severe intraventricular hemorrhage or patent ductus arteriosus.
Conclusions:
- Prophylactic indomethacin (PI) administration is linked to improved survival rates in extremely premature (EP) infants referred to a level IV Children's Hospital NICU.
- PI did not demonstrate a significant effect on severe intraventricular hemorrhage or patent ductus arteriosus ligation.
- The findings suggest a potential benefit of PI for survival in this specific high-risk neonatal population.
Objective:
We examined data from a contemporary cohort of extreme prematurity (EP) infants admitted to an all-referral Children's Hospital neonatal intensive care unit (NICU) to determine whether prophylactic indomethacin (PI) may continue to benefit these patients.
Study Design:
An observational study utilizing the small baby ICU data registry that was queried for all EP infants admitted between 2005 and 2014 with documentation of PI use (671 total EP infants; 141 (21%) did not receive PI (control); 530 (79%) received PI (PI). This cohort of EP infants was born at outside hospitals and transferred to our level IV NICU with a mean age on admission of 13 days, well after the PI would have been administered.
Results:
No difference existed between the control and PI groups in gestational age, birth weight, severity of illness, other in-hospital outcomes or developmental delay. PI infants had a significantly lower mortality rate (P=0.0004), lower relative risk (RR) for mortality 0.52 (95% confidence interval (CI) 0.37 to 0.73, P=0.0001) and lower RR of developing the combined outcome of death or bronchopulmonary dysplasia (RR 0.91, 95% CI 0.85 to 0.98, P=0.012) when compared with the control group. Notably, there was no significant effect of PI on incidence of severe intraventricular hemorrhage or patent ductus arteriosus ligation.
Conclusion:
PI administration was associated with improved survival in EP infants referred to a level IV Children's Hospital NICU.
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