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PMID: 20614421 Published · epublish English Journal Article Meta-Analysis Review Systematic Review

Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants.

The Cochrane database of systematic reviews ·No. 7 ·2010-07-07 ·Pages CD000174

Fowlie PW, Davis PG, McGuire W

Abstract

Persistent patent ductus arteriosus (PDA) is associated with mortality and morbidity in preterm infants. Prostaglandin synthetase inhibitors such as indomethacin promote PDA closure but also have potential side effects. The effect of the prophylactic use of indomethacin, where infants who may not have gone on to develop a symptomatic PDA would be exposed to indomethacin, warrants particular scrutiny. To determine the effect of prophylactic indomethacin on mortality and morbidity in preterm infants. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 5, 2010), MEDLINE, EMBASE and CINAHL (until April 2010), conference proceedings, and previous reviews. Randomised or quasi-randomised controlled trials that compared prophylactic indomethacin versus placebo or no drug in preterm infants. The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two review authors. Nineteen eligible trials in which 2872 infants participated were identified. Most participants were very low birth weight, but the largest single trial restricted participation to extremely low birth weight infants (N = 1202). The trials were generally of good quality.The incidence of symptomatic PDA [typical relative risk (RR) 0.44, 95% confidence interval (CI) 0.38 to 0.50] and PDA surgical ligation (typical RR 0.51, 95% CI 0.37,0.71) was significantly lower in treated infants. Prophylactic indomethacin also significantly reduced the incidence of severe intraventricular haemorrhage (typical RR 0.66, 95% CI 0.53 to 0.82). Meta-analyses found no evidence of an effect on mortality (typical RR 0.96, 95% CI 0.81 to 1.12) or on a composite of death or severe neurodevelopmental disability assessed at 18 to 36 months old (typical RR 1.02, 95% CI 0.90, 1.15). Prophylactic indomethacin has short-term benefits for preterm infants including a reduction in the incidence of symptomatic PDA, PDA surgical ligation, and severe intraventricular haemorrhage. However, there is no evidence of effect on mortality or neurodevelopment.

MeSH Terms
Cardiovascular Agents/administration & dosage,adverse effects Cerebral Hemorrhage/mortality,prevention & control Ductus Arteriosus, Patent/prevention & control Humans Indomethacin/administration & dosage,adverse effects Infant, Extremely Low Birth Weight Infant, Newborn Infant, Premature, Diseases/mortality Infant, Very Low Birth Weight Injections, Intravenous Randomized Controlled Trials as Topic
Chemicals
Cardiovascular Agents Indomethacin
Authors & Affiliations
3 authors, click to expand affiliations / ORCID
Fowlie Peter W
Women & Child Health, Ninewells Hospital and Medical School, Dundee, Scotland, UK, DD1 9SY.
Davis Peter G
McGuire William
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Article Info
Journal
The Cochrane database of systematic reviews
Abbr.
Cochrane Database Syst Rev
ISSN
1469-493X
DOI
10.1002/14651858.CD000174.pub2
Published
2010-07-07
Epub
2010-00-07
Pages
CD000174
Language
English
Region
England
NLM ID
100909747
PMCID
PMC7045285
Subset
IM
Corrections
UpdateOf
PMID: 12137607
External Links
PubMed source DOI: 10.1002/14651858.CD000174.pub2 PMC Full Text View journal details
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