Szakmar Eniko, Harrison Sasha, Elshibiny Hoda, Munster Chelsea, El-Dib Mohamed
Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary.
J Neonatal Perinatal Med. 2025 Sep;18(5):449-455. doi: 10.1177/19345798251349748. Epub 2025 Jun 19.
BackgroundProphylactic indomethacin in preterm infants has been associated with reduction of severe intraventricular hemorrhage (SIVH) but no improvement in neurodevelopmental outcome. Since January 2016, Brigham and Women's Hospital has implemented a clinical practice guideline (CPG) for prophylactic indomethacin to prevent SIVH. Our aim was to compare the predicted and observed rate of SIVH before and after CPG implementation. Second, to evaluate the association between indomethacin and development of SIVH.MethodsThis retrospective cohort study included infants born between 23 and 28 weeks of gestation. Variables were compared between before (pre-group) and after the CPG implementation (post-group). Risk categories for SIVH were defined as the following based on a validated model: low <15%, moderate ≥15% to <25%, and high risk ≥25%. Multivariate logistic regression model was applied to evaluate the association between SIVH and the administration of indomethacin.ResultsInfants in the post-group ( = 325) presented with lower Apgar scores, higher rate of necrotizing enterocolitis, abdominal surgery, and mortality comparing to pre-group ( = 424). The use of indomethacin for any reason was 44% in pre-group and 62% in post-group ( < 0.001). There was no significant difference in the predicted and observed rate of SIVH between the 2 groups in any risk categories. There was no association between the use of indomethacin and development of SIVH in multivariate regression models.ConclusionThe implementation of CPG for prophylactic indomethacin was not associated with reduction in the incidence of SIVH and no association was found between the use of indomethacin and development of SIVH.
背景
早产儿预防性使用吲哚美辛与严重脑室内出血（SIVH）的减少有关，但神经发育结局并无改善。自2016年1月起，布莱根妇女医院实施了一项关于预防性使用吲哚美辛以预防SIVH的临床实践指南（CPG）。我们的目的是比较CPG实施前后SIVH的预测发生率和观察到的发生率。其次，评估吲哚美辛与SIVH发生之间的关联。
方法
这项回顾性队列研究纳入了妊娠23至28周出生的婴儿。对CPG实施前（预组）和实施后（后组）的变量进行了比较。根据一个经过验证的模型，SIVH的风险类别定义如下：低风险<15%，中度风险≥15%至<25%，高风险≥25%。应用多因素逻辑回归模型评估SIVH与吲哚美辛给药之间的关联。
结果
与预组（n = 424）相比，后组（n = 325）的婴儿Apgar评分较低，坏死性小肠结肠炎、腹部手术和死亡率较高。预组因任何原因使用吲哚美辛的比例为44%，后组为62%（P < 0.001）。在任何风险类别中，两组之间SIVH的预测发生率和观察到的发生率均无显著差异。在多因素回归模型中，吲哚美辛的使用与SIVH的发生之间没有关联。
结论
预防性使用吲哚美辛的CPG实施与SIVH发生率的降低无关，且未发现吲哚美辛的使用与SIVH的发生之间存在关联。
