Does Indomethacin Prophylaxis Benefit Extremely Low Birth Weight Infants? Results of a Placebo-Controlled Multicenter Trial

A review of: Schmidt B, Davis P, Moddemann D, Ohlsson A et al. 2001 Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med 344:1966–1972

The advances in perinatal care have substantially reduced the mortality of extremely low-birth-weight (ELBW;< 1000 g) infants. However, it has been difficult to reduce the proportion of impaired survivors. In an effort to reduce these impairments, some neonatologists administer low-dose indomethacin prophylaxis to ELBW infants within the first hours after birth. This intervention reduces the incidence of not only patent ductus arteriosus but also intraventricular or periventricular hemorrhage (as diagnosed using cranial sonography) (1). However, indomethacin prophylaxis has not been widely used because of concern that it might increase ischemic brain injury, retinopathy of prematurity, necrotizing enterocolitis, or gastrointestinal perforation.

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