Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants

• Published in: Pediatrics (Evanston) Vol. 134; no. 5; pp. e1369 - e1377
• Main Authors: Kelleher, John, Salas, Ariel A, Bhat, Ramachandra, Ambalavanan, Namasivayam, Saha, Shampa, Stoll, Barbara J, Bell, Edward F, Walsh, Michele C, Laptook, Abbot R, Sánchez, Pablo J, Shankaran, Seetha, VanMeurs, Krisa P, Hale, Ellen C, Newman, Nancy S, Ball, M Bethany, Das, Abhik, Higgins, Rosemary D, Peralta-Carcelen, Myriam, Carlo, Waldemar A
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01-11-2014
• Subjects: Babies; Birth weight; Birth weight, Low; Care and treatment; Cohort Studies; Dosage and administration; Female; Follow-Up Studies; Health aspects; Hemorrhage; Humans; Indomethacin; Indomethacin - administration & dosage; Infant, Extremely Low Birth Weight - growth & development; Infant, Newborn; Infants; Injuries; Intestinal perforation; Intestinal Perforation - diagnosis; Intestinal Perforation - prevention & control; Intestines; Low birth weight; Male; Nutrition; Pediatrics; Prospective Studies; Retrospective Studies; Risk assessment; Risk factors; necrotizing enterocolitis; neonate; intestinal perforation; indomethacin
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2014-0183

Prophylactic indomethacin reduces severe intraventricular hemorrhage but may increase spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants. Early feedings improve nutritional outcomes but may increase the risk of SIP. Despite their benefits, use of these therapies varies largely by physician preferences in part because of the concern for SIP.
This was a cohort study of 15,751 ELBW infants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 1999 to 2010 who survived beyond 12 hours after birth. The risk of SIP was compared between groups of infants with and without exposure to prophylactic indomethacin and early feeding in unadjusted analyses and in analyses adjusted for center and for risks of SIP.
Among infants exposed to prophylactic indomethacin, the risk of SIP did not differ between the indomethacin/early-feeding group compared with the indomethacin/no-early-feeding group (adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.49-1.11). The risk of SIP was lower in the indomethacin/early-feeding group compared with the no indomethacin/no-early-feeding group (adjusted RR 0.58, 95% CI 0.37-0.90, P = .0159). Among infants not exposed to indomethacin, early feeding was associated with a lower risk of SIP compared with the no early feeding group (adjusted RR 0.53, 95% CI 0.36-0.777, P = .0011).
The combined or individual use of prophylactic indomethacin and early feeding was not associated with an increased risk of SIP in ELBW infants.