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Indomethacin Prophylaxis in Preterm Infants: Changes over Time.

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Indomethacin prophylaxis use in NICUs remained stable until 2014, then decreased by 2018. 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 Research

Background:

  • Indomethacin prophylaxis is used in Neonatal Intensive Care Units (NICUs) to prevent conditions like intraventricular hemorrhage.
  • Trends in its utilization may reflect evolving clinical practices and evidence.

Purpose of the Study:

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

Main Methods:

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

Main Results:

  • Overall indomethacin prophylaxis use was 16%.
  • A significant decrease in use was observed between 2014 and 2018 (p=0.046), though not significantly between 2008-2018.
  • Among 74 centers, 57% decreased indomethacin use, while 20% increased it.
  • Half of the centers with the largest changes showed an inverse correlation between indomethacin use and severe IVH, while the other half showed a positive correlation.

Conclusions:

  • Indomethacin prophylaxis use remained stable until 2014, then declined through 2018.
  • Significant center-level variability in indomethacin use persists.
  • Changes in indomethacin prophylaxis prevalence did not consistently correlate with severe IVH rates across NICUs.