Table of Contents

HK J Paediatr (New Series)
Vol 20. No. 2, 2015

HK J Paediatr (New Series) 2015;20:62-70

Original Article

Outcomes of Prophylactic Indomethacin for Extremely Low Birth Weight Infants

HY Chang, HL Lung, ST Li, CY Lin, HC Lee, CH Lee, HF Hung, CC Peng


Background: Prophylactic indomethacin (PI) administered to preterm infants has been shown to decrease severe intraventricular haemorrhage (IVH) and the need for surgical ligation of patent ductus arteriosus (PDA). The aim of this study was to compare the short-term and long-term outcomes of a PI-treated group (Indo group) with a recent retrospective, historical cohort (control group). Methods: We performed a retrospective review of 85 infants, 40 iodomethacin-treated and 45 untreated controls, born ≤28 weeks' gestation and weighing <1000 g. Short-term outcomes and neurodevelopmental outcomes at 24 months of corrected age were compared between the two groups. Results: Severe IVH was less in the Indo group (7.5%) than in the control group (13.3%), but this difference did not reach statistical difference (P=0.38). The occurrence of significant PDA was significantly lower in the Indo group (30%) compared to the control group (51%) (P=0.04). Patients who received PI experienced a decreased PDA surgical ligation rate (control group = 35.6%, Indo group = 12%; P=0.01). This statistical difference persisted even after logistic regression analysis (P=0.04). At 2 years, no significant differences were found between the groups in terms of Mental development index and the psychomotor development index scores <70, the incidence of cerebral palsy, neurodevelopmental impairment, or composite outcomes. Conclusion: PI decreased surgical PDA in preterm infants. However, PI did not cause an improvement in neurodevelopmental outcomes once these children reached 2 years. PDA may play a limited role in the multifactorial factors in the causation of neurodevelopmental impairment of preterm infants.

背景:早產兒預防性使用吲哚美辛(PI)可以減少出現嚴重腦室內出血(IVH)和動脈導管未閉(PDA)手術結紮率。本研究旨在比較PI治療組和對照組短期和長期的治療效果。方法:我們回顧性研究了85例患兒的病例資料,40名患兒預防性應用吲哚美辛,45名患兒沒有用藥作為對照組。所有患兒孕週均小於28週,出生體重小於1000 g。對兩組進行短期療效和矯正胎齡24個月時神經系統發育情況的比較。結果:嚴重的腦室內出血發生率在PI治療組(7.5%)較對照組(13.3%)少,但是沒有統計學差異(P=0.38)。明顯的動脈導管未閉發生率在PI治療組(30%)較對照組(51%)顯著降低(P=0.04)。接受PI治療的患兒其動脈導管未閉手術結紮率較低(對照組為35.6%,吲哚美辛治療組為12%,P=0.01)。邏輯回歸分析中仍然具有統計學意義(P=0.04)。在2歲時,兩組在MDI或PDI評分小於70,腦癱發生率、神經發育障礙或綜合表現上都沒有明顯差異。結論:預防性使用吲哚美辛減少早產兒需要手術治療PDA的發生率。但是吲哚美辛並不會改善這些兒童2歲時神經系統的發育結果。PDA在導致早產兒神經系統發育障礙的多種因素中的作用可能有限。

Keyword : Extremely low birth weight infant; Indomethacin prophylaxis; Intraventricular haemorrhage; Patent ductus arteriosus; Premature infant



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