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Effects of early indomethacin administration on oxygenation and surfactant requirement in low birth weight infants
1Department of Pediatrics, King Fahd Hospital of the University, Alkhobar, Saudi Arabia.
Insights
Early indomethacin in premature infants receiving mechanical ventilation increased the need for oxygen and surfactant. This suggests caution when using early indomethacin in very low birth weight neonates.
Area of Science:
- Neonatalogy
- Pharmacology
- Respiratory Medicine
Background:
- Previous research indicated early intravenous indomethacin prolonged respiratory support in very low birth weight infants.
- Indomethacin is a nonsteroidal anti-inflammatory drug often used in neonates.
Purpose of the Study:
- To evaluate the impact of early indomethacin administration on oxygenation and surfactant requirements in preterm, low birth weight infants.
- To compare oxygenation parameters (FiO2, a/A O2 ratio) and surfactant doses between infants receiving early indomethacin and placebo.
Main Methods:
- A randomized, double-blind, controlled study was conducted.
- Premature neonates on mechanical ventilation and surfactant therapy were randomized to receive either placebo or early indomethacin (0.2 mg/kg at 12h and two subsequent doses).
- Oxygenation was assessed via FiO2 and a/A O2 ratio over 48 hours; surfactant doses were compared.
Main Results:
- Twenty-seven infants (14 indomethacin, 13 placebo) met criteria; baseline characteristics were similar.
- The placebo group showed significantly improved oxygenation at 24 and 48 hours compared to the early indomethacin group.
- The early indomethacin group required significantly more surfactant (P = 0.029).
Conclusions:
- Early indomethacin administration in mechanically ventilated preterm infants increases oxygen and surfactant requirements.
- These findings suggest that early indomethacin may negatively impact respiratory outcomes in this vulnerable population.
- Further research is warranted to explore alternative strategies for managing conditions requiring indomethacin in neonates.
Abstract:
A previous study found that early intravenous indomethacin administration prolonged respiratory support in very low birth weight infants. We have, therefore, designed a randomized, double blind controlled study to evaluate the oxygenation, and surfactant requirements in preterm low birth weight infants receiving early indomethacin administration. Premature neonates who received surfactant therapy and on mechanical ventilation were prospectively randomized to receive either placebo or indomethacin (0.2 mg/kg intravenously at 12 postnatal hours and every 24 h for two more doses). Oxygenation was assessed by FiO2 required and arterial/alveolar oxygen (a/A O2) ratio during the first 48 h of life. The doses of surfactant were compared between the two groups. Twenty-seven infants (n = 14 of early indomethacin and n = 13 of placebo group) fulfilled inclusion criteria. At admission to the study, there were no differences in the birth weight, gestational age, sex, Apgar scores, a/A O2 ratio, and FiO2. The control group exhibited a significant improvement in oxygenation (FiO2 requirement and a/A O2 compared with the early indomethacin group at 24 (P = 0.026 and 0.02, respectively) and 48 h of life (P = 0.037 and 0.026, respectively). The requirement of surfactant was significantly larger in the early indomethacin group (P = 0.029). Early indomethacin administration increases oxygen and surfactant requirement.