VANCOUVER, B.C. – Indomethacin helps prevent intraventricular hemorrhages in infants born before 29 weeks to mothers who do not receive a full course of antenatal steroids, according to a small study at Weill Cornell Medical College in New York.
The study included 72 infants born at an average weight of 866 g and 26 weeks’ gestational age. Among the 17 born without optimal maternal courses of antenatal steroids (ANS), the investigators found that just one of eight children dosed with indomethacin developed a severe brain bleed, compared with six of nine who did not get indomethacin. The nonsteroidal anti-inflammatory drug was dosed in the first 6 hours of life – and continued every 24 hours for a total of three doses, if tolerated – at 0.1 mg/kg; it significantly reduced the risk of intraventricular hemorrhage (odds ratio, 14; 95% confidence interval, 1.73-172; P = .04).
M. Alexander Otto/Frontline Medical News
Dr. Morgan Spaight
"The administration of indomethacin to premature infants born at 28 weeks or less in the absence of optimal ANS almost eliminated severe IVH [intraventricular hemorrhage] over a 2- year period," concluded the investigators, led by neonatologist Dr. Morgan Spaight, a fellow at Cornell.
"Most of the time, infants [there] get complete ANS courses" when indicated, "and we’ve seen a huge decline in our rates of severe intraventricular hemorrhages. At the same time, we are still seeing born infants that we need to shunt for post-hemorrhagic hydrocephalus; a majority of them were not exposed to antenatal steroids, either at all or [not completely]. This may be the first time indomethacin has been targeted for infants that did not receive optimal antenatal steroids," she said at the annual meeting of the Pediatric Academic Societies.
"We implemented a plan to target these infants specifically" with indomethacin. "We found that it significantly decreased the amount of severe IVH, although there are times we can’t complete the three doses because we are worried about adverse events," such as spontaneous intestinal perforation, she said.
Earlier studies have questioned the long-term benefit of indomethacin, but "there’s a pretty strong connection between severe IVH and bad outcomes, so we feel that preventing" it with indomethacin, when women don’t get a full course of ANS, "has to be a good thing," she said.
Infants who received indomethacin were born, on average, earlier than those who did not (24 vs. 27 weeks) and at lower average weights (652 vs. 972 g).
Dr. Spaight had no disclosures, and the work had no outside funding.