Prophylactic indomethacin: systematic review and meta-analysis

Fowlie, PW

doi:10.1016/s0022-3476(96)70092-6

Cited by 9 publications

(14 citation statements)

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Section: Discussionmentioning

confidence: 99%

“…In the early 1980s the use of indomethacin has been implicated, followed by randomized controlled trials [19][20][21]23] of prophylactic administration. Although these trials reported effectiveness of indomethacin administration in preventing IVH and PDA, unexpected side effects secondary to decreased splanchicus blood flow resulted in a restrain from a universal recommendation of the use of indomethacin [19]. Controversially, O'Donovan et al [35], in a retrospective study, and Cooke et al [13] for the Cochrane Neonatal Collaborative Review Group, concluded that prophylactic indomethacin treatment was not associated with an increased risk for the development of NEC.…”

Section: Discussionmentioning

confidence: 99%

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Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

et al. 2006

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For the first time a multimodal approach to NEC prophylaxis is reported, consisting of early trophic feeding with human breast milk, and enteral administration of an antibiotic, an antifungal agent, and probiotics. A retrospective analysis of local protocol of NEC prophylaxis is presented. Included were all VLBWI admitted to the NICU, including transfers within the first 28 days of life. These infants were divided into two groups, an "inborn group" (infants admitted within the first 24 h of life) and an "outborn group" (infants admitted after the onset of their second day of life). Prophylaxis of NEC according to protocol was started at the day of admission, and was continued until discharge. Between 1998 and 2004, 405 VLBWI were admitted, including all transfers within the first 28 days of life. A total of 334 (82%) infants were admitted within the first 24 h of life (inborn group), and 71 (18%) were admitted after 24 h of life (outborn group). Five infants developed clinical features of necrotizing enterocolitis. The inborn group showed a NEC incidence of 0.7% (two infants), whereas the outborn group showed a NEC incidence of 4.5% (three infants), respectively. This difference was significant (P=0.049, Fisher's exact test). A surgical treatment with bowel resection was performed in two infants (both from the outborn group). The present study used a combination of different strategies, all having shown to have some beneficial effect, but not having brought a clinical breakthrough in single administration studies. Combinated were the beneficial effects of human breast milk feeding, oral antiobiotics, oral antifungal agents, and the administration of probiotics. In a homogenous group of preterm infants, using this protocol of multimodal NEC prophylaxis, there was a very low incidence of NEC, when started within the first 24 h of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

et al. 2006

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“…A meta-analysis has demonstrated that early indomethacin treatment in preterm neonates can reduce the incidence of intraventricular haemorrhage [11]. The mechanisms of the protective eect of indomethacin are not known, but constriction/closure of a PDA is one possibility.…”

Section: Discussionmentioning

confidence: 99%

A patent ductus arteriosus is associated with reduced middle cerebral artery blood flow velocity

Weir¹,

Ohlsson²,

Myhr³

et al. 1999

European Journal of Pediatrics

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“…It is interesting to note that infants who were diagnosed with PDA were at a significantly higher risk of BPD despite the early, aggressive, and successful treatment of PDA with indomethacin. However, as alluded to earlier, prophylactic treatment of ductus with indomethacin in preterm infants with RDS has been unsuccessful in preventing BPD [10,12].…”

Section: Discussionmentioning

confidence: 98%

“…Moreover, prophylactic treatment of ductus with indomethacin remains controversial at best [12]. Prophylactic treatment of patent ductus also does not decrease pulmonary morbidity as compared with the early symptomatic treatment [2].…”

Section: Discussionmentioning

confidence: 99%

Effect of Dexamethasone Therapy on the Neonatal Ductus Arteriosus

Morales¹,

Rastogi²,

Bez³

et al. 1998

Pediatr Cardiol

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Patent ductus arteriosus (PDA) is believed to be a contributing factor in the etiopathogenesis of bronchopulmonary dysplasia (BPD). We studied the effects of early dexamethasone therapy on persistent ductal patency and the role of PDA in the etiopathogenesis of BPD during the course of a randomized double-blind trial of dexamethasone to prevent BPD. Infants, who weighed between 700 and 999 g, had severe RDS, and had been given surfactant, were randomized to receive a 12-day course of dexamethasone (n = 13) or placebo (n = 17) starting within the first 12 hours of postnatal life. The diagnosis of PDA was made clinically and was confirmed by cardiac ultrasound. The incidence of clinically significant ductus in infants who weighed less than 1000 g was 23% in the dexamethasone-treated group, as compared with 59% in infants who were given placebo. This difference was marginally significant, p = 0.05, odds ratio 0.21, 95% confidence interval 0.04-1.05. None of the infants in the dexamethasone group had recurrence of PDA after indomethacin therapy as compared with three infants in the placebo group. Dexamethasone significantly reduced the number of days infants required ventilator and supplemental oxygen as compared with infants who received placebo. Dexamethasone, as compared with placebo, also reduced the incidence of BPD, p = 0.025, odds ratio 0.08, 95% confidence interval 0.01-0.58. Dexamethasone may reduce the incidence of PDA in premature infants who weigh less than 1000 g at birth and thereby reduce the incidence of BPD.

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Prophylactic indomethacin: systematic review and meta-analysis

Cited by 9 publications

References 0 publications

Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

A patent ductus arteriosus is associated with reduced middle cerebral artery blood flow velocity

Effect of Dexamethasone Therapy on the Neonatal Ductus Arteriosus

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