Effects of Indomethacin on Resting Cerebral Hemodynamic and During Suctioning in Preterm Neonates

Abstract

The effect of therapeutic doses of indomethacin versus a placebo on cerebral hemodynamics was studied in nine preterm infants using Doppler ultrasound. Three doses of indomethacin (0.2 mg/kg) induced a significant decrease in the mean frequency compared to the placebo. Heart rate, blood pressure, transcutaneous carbon dioxide tension, and transcutaneous oxygen tension remained stable throughout the study. The changes in mean frequency occurred rapidly and were sustained at significantly diminished levels for at least 1 hour. All infants were mechanically ventilated, and the increase of mean frequency secondary to suctioning was significantly attenuated after each dose of indomethacin as compared to the placebo. The results confirmed that infusion of indomethacin caused a reduction in cerebral blood flow, probably by vasoconstriction of cerebral vessels. Indomethacin also seemed to attenuate the cerebrovascular response to hypercapnia induced by endotracheal suctioning. Even so, and because of the alteration of resting cerebral hemodynamics, we do not support the recommendation that indomethacin should be used prophylactically to prevent patent ductus arterious or periventricular intraventricular hemorrhage.