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Indomethacin Prophylaxis in Preterm Infants: Changes over Time.

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Indomethacin prophylaxis use in neonatal intensive care units (NICUs) remained stable until 2014, then decreased. Changes in indomethacin use did not consistently correlate with severe intraventricular hemorrhage rates across centers.

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Area of Science:

  • Neonatal Medicine
  • Pharmacology
  • Clinical Pediatrics

Background:

  • Indomethacin prophylaxis is used to prevent severe intraventricular hemorrhage in premature infants.
  • Trends in indomethacin use and its association with intraventricular hemorrhage (IVH) require examination.

Purpose of the Study:

  • To analyze changes in indomethacin prophylaxis use in neonatal intensive care units (NICUs) from 2008 to 2018.
  • To investigate the correlation between indomethacin use and severe intraventricular hemorrhage (IVH) prevalence.

Main Methods:

  • A cohort study of 19,715 infants born between 22 and 26 weeks' gestation across 213 NICUs.
  • Nonparametric trend tests evaluated indomethacin prophylaxis use over time.
  • Correlation analysis between indomethacin use and severe IVH prevalence in select centers.

Main Results:

  • Overall indomethacin prophylaxis use did not significantly decrease from 2008-2018, but showed a significant decrease between 2014-2018 (p=0.046).
  • While 57% of centers decreased indomethacin use, 20% increased it during the study period.
  • Among centers with the largest changes, 50% showed an inverse correlation and 50% a positive correlation between indomethacin use and severe IVH.

Conclusions:

  • Indomethacin prophylaxis use remained stable until 2014, then declined, with significant center-to-center variability.
  • Changes in indomethacin prophylaxis prevalence did not consistently correlate with severe intraventricular hemorrhage prevalence.
  • Persistent variability in indomethacin use across NICUs highlights the need for further research and guideline refinement.