Document Detail


Outcome of very low birth weight infants exposed to antenatal indomethacin for tocolysis.
MedLine Citation:
PMID:  15861198     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Beginning in October 1995, and for several years thereafter, our institution used indomethacin as a first-line tocolytic drug. Our purpose is to compare the outcomes of very low birth weight infants who were exposed to antenatal indomethacin with those who were not exposed to this therapy. STUDY DESIGN: We used our center's component of the NICHD Neonatal Research Network's Generic Data Base which recorded the outcomes of all live born infants weighing less than 1500 g over a 5-year period. We abstracted data concerning neonatal morbidity (death, Grades III to IV intraventricular hemorrhage (IVH), necrotizing enterocolitis and patent ductus arteriosus), as well as other factors including gestational age, birth weight, antenatal corticosteroid treatment and maternal hypertension or pre-eclampsia. Univariate analysis was performed using Fisher's exact test. Multivariate analysis using logistic regression was performed to control for confounding factors. RESULTS: A total of 85 infants who were exposed to antenatal indomethacin were compared to 464 infants who were not exposed to the drug. In the univariate analysis, antenatal indomethacin exposure was not associated with a significant increase in the incidence of necrotizing enterocolitis or patent ductus arteriosus. The incidence of Grades III to IV IVH was 17.9% in those infants exposed to antenatal indomethacin compared to 7.1% in the nonexposed infants (p=0.008). The incidence of neonatal death in the exposed infants was 27.7 versus 16.4 in the nonexposed infants (p=0.02). After controlling for antenatal corticosteroids, maternal pre-eclampsia, gestational age and birth weight, antenatal indomethacin was significantly associated with an increased incidence of IVH, but not neonatal death. CONCLUSION: Antenatal indomethacin was associated with significantly higher rates of IVH. Additional studies assessing the potential risks of indomethacin tocolysis are needed before it is used as a first-line tocolytic therapy.
Authors:
Nora M Doyle; Michael O Gardner; Lorraine Wells; Clifford Qualls; Lu-Ann Papile
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  25     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-29     Completed Date:  2005-08-30     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  336-40     Citation Subset:  IM    
Affiliation:
Department of Obstetrics, Division of Maternal Fetal Medicine, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Cause of Death*
Cohort Studies
Critical Care
Ductus Arteriosus, Patent / chemically induced,  mortality,  physiopathology
Enterocolitis, Necrotizing / chemically induced,  mortality,  physiopathology
Female
Follow-Up Studies
Humans
Indomethacin / adverse effects*,  therapeutic use
Infant, Newborn
Infant, Premature, Diseases / chemically induced*,  mortality*,  physiopathology
Infant, Very Low Birth Weight*
Intensive Care Units, Neonatal
Intracranial Hemorrhages / chemically induced,  mortality,  physiopathology
Logistic Models
Male
Pregnancy
Prenatal Exposure Delayed Effects*
Probability
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Tocolysis / adverse effects
Chemical
Reg. No./Substance:
53-86-1/Indomethacin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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