Outcome of very low birth weight infants exposed to antenatal indomethacin for tocolysis

被引：16

作者：

Doyle N.M. ^{[1
,5
]}

Gardner M.O. ^{[2
]}

Wells L. ^{[3
]}

Qualls C. ^{[4
]}

Papile L.-A. ^{[3
]}

机构：

[1] Department of Obstetrics, Division of Maternal Fetal Medicine, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX

[2] Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX

[3] Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM

[4] General Clinical Research Center, University of New Mexico School of Medicine, Albuquerque, NM

[5] Houston, TX 77030

来源：

Journal of Perinatology | 2005年 / 25卷 / 5期

关键词：

D O I：

10.1038/sj.jp.7211256

中图分类号：

学科分类号：

摘要：

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 risk of indomethacin tocolysis are needed before it is used as a first-line tocolytic therapy. © 2005 Nature Publishing Group All rights reserved.

引用

页码：336 / 340

页数：4

共 25 条

[1]

McCormick M.C., The contribution of low birth weight to infant mortality and childhood morbidity, N. Engl. J. Med., 312, pp. 82-90, (1985)

[2]

Goldenberg R.L., Rouse D.J., Prevention of preterm birth, N. Engl. J. Med., 339, pp. 313-320, (1998)

[3]

Robertson P.A., Snickerman S.H., Laros Jr. R.K., Et al., Neonatal morbidity according to gestational age and birth weight from five tertiary care centers in the United States, 1983 through 1986, Am. J. Obstet. Gynecol., 166, 6 PART 1, pp. 1629-1641, (1992)

[4]

Cunningham F.G., MacDonald P.C., Gant N.F., Leveno K.J., Gilstrap III L.C., Williams Obstetrics, (1993)

[5]

Kimberlin D.F., Hauth J.C., Owen J., Et al., Indicated versus spontaneous preterm delivery: An evaluation of neonatal morbidity among infants weighing ≤ 1000 grams at birth, Am. J. Obstet. Gynecol., 180, pp. 683-689, (1999)

[6]

Iams J.D., Preterm labor, Clin. Obstet. Gynecol., 38, (1995)

[7]

Hill W.C., Risks and complications of tocolysis, Clin. Obstet. Gynecol., 38, pp. 725-745, (1995)

[8]

Gamissans O., Balasch J., Prostaglandin synthetase inhibitors in the treatment of preterm birth, Preterm Birth-Causes, Prevention, and Management, pp. 309-332, (1993)

[9]

Gordon M.C., Samuels P., Indomethacin, Clin. Obstet. Gynecol., 38, pp. 697-705, (1995)

[10]

Zuckerman H., Shalev E., Gilad G., Katzuni E., Further study of the inhibition of premature labor by indomethacin Part 1, J. Perinatal Med., 12, pp. 19-29, (1984)

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