Mirza Hussnain, Laptook Abbot R, Oh William, Vohr Betty R, Stoll Barbara J, Kandefer Sarah, Stonestreet Barbara S
Center for Neonatal Care, Florida Hospital for Children/UCF College of Medicine, Orlando, Florida, USA.
Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA.
Arch Dis Child Fetal Neonatal Ed. 2016 Sep;101(5):F418-22. doi: 10.1136/archdischild-2015-309112. Epub 2016 Jan 5.
Indomethacin prophylaxis (IP) reduces the risk of intraventricular haemorrhage (IVH) and patent ductus arteriosus (PDA) in preterm infants. However, the optimal time to administer IP has not been determined. We hypothesised that IP at ≤6 h is associated with a lower incidence of IVH or death than if administered at >6-24 h of age.
We performed a retrospective cohort study of extremely low birth weight infants (≤1000 g birth weight) treated in the neonatal intensive care units in the Neonatal Research Network from 2003 to 2010 and who received IP in the first 24 h of age. Infants were dichotomised based upon receipt of IP at ≤6 or >6-24 h of age. The primary outcomes were IVH alone and IVH or death. Secondary outcomes were PDA alone and PDA or death. We used multivariable analyses to determine associations between the age of IP and the study outcomes expressed as an OR and 95% CI.
IP was given at ≤6 h to 2340 infants and at >6-24 h to 1915 infants. Infants given IP at ≤6 h had more antenatal steroid exposure, more inborn and less cardiopulmonary resuscitation (p<0.01). After multivariable analyses, age of IP receipt was not associated with IVH, and IVH or death but PDA receiving treatment/ligation or death was lower among IP at ≤6 h compared with IP at >6-24 h (OR 0.83, 95% CI 0.71 to 0.98).
IP at ≤6 h of age is not associated with less IVH or death, but is associated with less PDA receiving treatment/ligation or death.
吲哚美辛预防（IP）可降低早产儿脑室内出血（IVH）和动脉导管未闭（PDA）的风险。然而，IP的最佳给药时间尚未确定。我们假设，与在出生后>6 - 24小时给药相比，在≤6小时给予IP可降低IVH或死亡的发生率。
我们对2003年至2010年在新生儿研究网络的新生儿重症监护病房接受治疗且在出生后24小时内接受IP的极低出生体重婴儿（出生体重≤1000克）进行了一项回顾性队列研究。根据在≤6小时或>6 - 24小时接受IP将婴儿分为两组。主要结局是单纯IVH以及IVH或死亡。次要结局是单纯PDA以及PDA或死亡。我们使用多变量分析来确定IP给药年龄与以OR和95%CI表示的研究结局之间的关联。
2340名婴儿在≤6小时接受了IP，1915名婴儿在>6 - 24小时接受了IP。在≤6小时接受IP的婴儿有更多的产前类固醇暴露、更多的先天因素且更少接受心肺复苏（p<0.01）。经过多变量分析，IP给药年龄与IVH、IVH或死亡无关，但与>6 - 24小时接受IP相比，在≤6小时接受IP的婴儿中接受治疗/结扎或死亡的PDA发生率更低（OR 0.83，95%CI 0.71至0.98）。
在≤6小时给予IP与较少的IVH或死亡无关，但与较少的接受治疗/结扎或死亡的PDA有关。
