Gestational Age-Dependent Variations in Effects of Prophylac
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A Study was conducted to evaluate the impact of prophylactic indomethacin on early death (less than 10 days after birth) or severe neurological injury and on early death or spontaneous intestinal perforation by completed weeks of gestational age (GA) in neonates born less than 29 weeks gestation.

Neonatal neonates (N=12515) born at 23 to 28 weeks GA, admitted to neonatal intensive care units participating in the Canadian Neonatal Network, and given prophylactic indomethacin starting within the first 12 hours after birth were studied in a multicenter retrospective cohort sample. Early death or serious neurological damage versus early death or spontaneous intestinal perforation were compared using univariate and multivariate analysis.

Results
--Of 12515 eligible neonates, 1435 (11.5%) were exposed to prophylactic indomethacin;

--Recipients were of lower GA and birth weight and had higher severity of illness (Score for Neonatal Acute Physiology, SNAPII-PE score) on admission compared with non-recipients.

--After adjusting for confounders, prophylactic indomethacin was associated with reduced odds of early death or severe neurological injury and early death or spontaneous intestinal perforation in neonates born at 23 to 24 weeks GA.

--However, prophylactic indomethacin was associated with increased odds of early mortality or spontaneous intestinal perforation for neonates born at 26 to 28 weeks GA.

Finally, prophylactic indomethacin use was associated with gain in neonates born between 23 and 24 weeks gestational age, but with harm in those born between 26 and 28 weeks gestational age. A randomized controlled trial is required to examine the effect of prophylactic indomethacin in babies born at 23 to 25 weeks GA, based on the observation of significantly improved survival.

Source: https://www.jpeds.com/article/S0022-3476(21)00216-X/fulltext?rss=yes
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