Prophylactic indomethacin has been studied in the prevention of patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH). Fowlie (1996) reported a systematic overview of 14 randomized controlled trials of prophylactic indomethacin noting a decrease in the risk of PDA, IVH, and severe IVH associated with prophylactic indomethacin administration. However, use of prophylactic indomethacin is not widespread due to concern regarding possible side effects of treatment.
We examined three decision choices regarding the use of indomethacin: (1) prophylactic treatment with indomethacin in all high risk infants, (2) ultrasound screening for baseline intraventricular hemorrhage, or (3) indomethacin treatment of symptomatic patent ductus arteriosus. In the ultrasound screening strategy, baseline IVH status is ascertained and only infants with minor IVH or no IVH receive therapy. In the symptomatic treatment branch, early indomethacin therapy is withheld and used only if needed for treatment of PDA. The decision tree incorporates estimates derived from the clinical literature regarding the baseline risks of intraventricular hemorrhage, patent ductus arteriosus, and the theoretical risk associated with indomethacin therapy. All surviving infants go to a common PDA subtree which evaluates the risks associated with indomethacin treatment of symptomatic PDA.
