PROPHYLACTIC INDOMETHACIN AND INTRAVENTRICULAR HEMORRHAGE (IVH) IN THE PREMATURE

Abstract

We have previously shown significant hemostatic derangements associated with IVH and have questioned the use of indomethacin [I] , a potent platelet anti-aggregating agent in infants vulnerable to IVH. During a prospective study of [I] prophylaxis for patent ductus arteriosus (PDA), we assessed the impact of [I] upon the incidence of IVH. Sixty one inborn infants were randomized by birth weight (Group A: <900 gm; Group B: 900-1300 gm) to receive either placebo [P] or [I] . The first dose (0.2 mg/kg), given within 12 hours after birth, was followed by two q 12 hourly doses (0.1 mg/kg). Cranial ultrasonography was performed prior to dose # 1, daily for 3 days and at 1 week. Abnormal scans were repeated weekly. The most severe grade of IVH (Papile criteria) sustained by each infant is shown below: In Group A, 2 of 10 (20%) of infants who received I developed IVH (Grades II-IV) in contrast to 8 of 10 (80%) of infants given [P], p < 0.025. In Group B, there was no significant difference in IVH between [I] and [P] These preliminary data suggest that prophylactic [I] may diminish the incidence of IVH in infants < 900 grams, perhaps by preventing clinically significant PDA or by altering prostaglandin-related central nervous system vascular phenomena.