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Use of Prophylactic Indomethacin in Preterm Infants: A Systematic Review and Meta-Analysis

Abdulrahman Al-Matary1, Amani Abu Shaheen2, Sameh Abozaid1

  • 1Neonatology Department, King Fahad Medical City, Riyadh, Saudi Arabia.

Frontiers in Pediatrics
|April 25, 2022
PubMed

Insights

Prophylactic indomethacin effectively reduces patent ductus arteriosus (PDA) and severe intraventricular hemorrhage (IVH) in preterm infants. However, its impact on other morbidities requires further investigation.

Area of Science:

  • Neonatal Medicine
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Prophylactic indomethacin is used to reduce morbidities in preterm infants.
  • Contradictory outcomes exist regarding its effectiveness, necessitating a systematic review.
  • Focus on cardiopulmonary and neurodevelopmental outcomes like intraventricular hemorrhage (IVH).

Approach:

  • Systematic review and meta-analysis of 23 randomized trials and cohort studies.
  • Comprehensive search of major scientific databases up to August 2021.
  • Assessment of prophylactic indomethacin's impact on various preterm infant morbidities.

Key Points:

  • Significantly lowered rates of patent ductus arteriosus (PDA) and surgical PDA ligation.
  • Reduced incidence of severe intraventricular hemorrhage (IVH).
  • No significant effect observed on bronchopulmonary dysplasia (BPD), mortality, or necrotizing enterocolitis.

Conclusions:

  • Meta-analysis results on prophylactic indomethacin effectiveness vary by study design.
  • Further evidence is needed for its efficacy, especially in very low birth weight infants.
  • Clarification required for outcomes like surgical PDA ligation and severe IVH.
Abstract

Keywords:
intraventricular hemorrhageneonatal outcomepatent ductus arteriosuspreterm infantsprophylactic indomethacin

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