Prophylactic indomethacin in the very low birth weight infant

Abstract

Indomethacin has been useful in the treatment of patent ductus arteriosus. During the last 10 years, it has been used prophylactically to decrease the incidences of intraventricular haemorrhage and patent ductus arteriosus. Objetive: To compare 2 prophylactic protocols with a non prophylactic group. Patient and Methods: Very low birthweight newborn (VLBW) less than 1 500 g and/or less than 32 weeks gestational age, were included. A historical group without prophylaxis n = 74, born 1994-1996, group I n = 71 born 1997-99 and group 2 n = 83 born 1999-2001 were studied. Congenital heart disease, severe asphyxia, genetic disorders and major malformations were factors of exclusion. Group I were given indomethacin 0.1mg/kg iv over 30 minutes at 6, 30 and 54 hours of life. Group 2 recieved a single dose at 6 hours. All patients were evaluated with CNS ultrasound at 3, 10 and 30 days of life, with echocardiography at 7 days. Results: There were no differences in patient characteristics between the studied groups. The historic group presented PDA in 14 (18.9%), 4 requiring surgical closure and IVH in 13 (17.5%). In group 16 (8.4%) presented PDA with no surgical treatment necessary, IVH en 9.8%. In group 2, 6 (8.4%) had PDA and 13 (15.7%) had IVH. The incidence of PDA can be decreased using 3 doses or a single dose of indomethacin, 55.5% and 61.9% respectively (p < 0.01). However IVH is only reduced with 3 doses 44% vs 10.28% respectively. Conclusions: Early prophylactic use of indomethacin can decrease the incidence of PDA, a single dose is as effective as 3 doses. However to reduce the incidence of IVH 3 doses are needed. Thus the choice of which protocol should be based on therapeutic goals, the reduction in cerebral plasma flow is the main mechanism of preventing haemorrhage. These results should encourage a randomised controlled trial.