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Early intravenous indomethacin prolongs respiratory support in very low birth weight infants
1Department of Paediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Early intravenous indomethacin therapy did not prevent chronic pulmonary disease of prematurity in newborns. While it reduced patent ductus arteriosus, infants receiving placebo were weaned from respiratory support sooner.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Prematurity poses significant risks for newborns, including chronic pulmonary disease.
- Respiratory support like intermittent positive pressure ventilation (IPPV) and continuous positive airway pressure (CPAP) is often required.
- Patent ductus arteriosus (PDA) is a common complication in premature infants.
Purpose of the Study:
- To evaluate the efficacy of early intravenous indomethacin therapy.
- To determine if indomethacin prevents chronic pulmonary disease of prematurity (CPDP).
- To assess the impact of indomethacin on respiratory support needs and PDA.
Main Methods:
- Randomized, double-blind, controlled trial involving 30 newborns.
- Infants received either intravenous indomethacin or placebo at 12, 24, and 36 hours of age.
- Groups were comparable in birth weight, gestational age, sex, hyaline membrane disease, and intracranial hemorrhage.
Main Results:
- Infants in the placebo group were weaned from IPPV earlier than those in the indomethacin group (p < 0.05).
- The incidence of chronic pulmonary disease of prematurity was similar between the indomethacin and placebo groups.
- Early indomethacin therapy significantly reduced the incidence of patent ductus arteriosus.
Conclusions:
- Early intravenous indomethacin therapy is not effective in preventing chronic pulmonary disease of prematurity.
- Indomethacin therapy may delay the weaning of respiratory support in preterm infants.
- Indomethacin effectively reduces the incidence of patent ductus arteriosus in this population.
Abstract:
Infants weighing 1500 g at birth requiring either intermittent positive pressure ventilation or continuous positive airway pressure by 12 hours of age were entered in a randomized double blind controlled trial to test the efficacy of early intravenous indomethacin therapy in preventing chronic pulmonary disease of prematurity. Of the 30 newborns enrolled, 15 were treated with indomethacin and 15 were treated with placebo at 12, 24 and 36 hours of age. The groups were similar for birth weight, gestational age, sex, hyaline membrane disease and intracranial hemorrhage. Infants in the placebo group were successfully weaned from intermittent positive pressure ventilation at an earlier age than infants in the indomethacin group (p less than 0.05). Furthermore, chronic pulmonary disease of prematurity was similar in the two groups despite a reduction in the incidence of patent ductus arteriosus in the indomethacin group.