Effects of early indomethacin administration on oxygenation and surfactant requirement in low birth weight infants.

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.