Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Erik A. Jensen, Kevin C. Dysart, Marie G. Gantz, Benjamin Carper, Rosemary D. Higgins, Martin Keszler, Matthew M. Laughon, Brenda B. Poindexter, Barbara J. Stoll, Michele C. Walsh, Barbara Schmidt, Michael S. Caplan, Richard A. Polin, Abbot R. Laptook, Martin Keszler, Angelita M. Hensman, Kristin M. Basso, Elisa Vieira, Emily Little & 31 others Avroy A. Fanaroff, Anna Marie Hibbs, Nancy S. Newman, William E. Truog, Howard W. Kilbride, Eugenia K. Pallotto, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Edward F. Donovan, Barbara Alexander, Cathy Grisby, Jody Hessling, Estelle E. Fischer, Lenora D. Jackson, Kristin Kirker, Greg Muthig, Ronald N. Goldberg, C. Michael Cotten, Kimberley A. Fisher, Kathy J. Auten, Katherine A. Foy, Sandra Grimes, Joanne Finkle, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, David P. Carlton

Research output: Contribution to journalArticle

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Abstract

Objective To assess the association between prophylactic indomethacin and bronchopulmonary dysplasia (BPD) in a recent, large cohort of extremely preterm infants. Study design Retrospective cohort study using prospectively collected data for infants with gestational ages < 29 weeks or birth weights of 401-1000 g born between 2008 and 2012 at participating hospitals of the National Institute of Child Health and Human Development Neonatal Research Network. Infants treated with indomethacin in the first 24 hours of life were compared with those who were not. Study outcomes were BPD, defined as use of supplemental oxygen at 36 weeks postmenstrual age among survivors to that time point, death, and the composite of death or BPD. Prespecified subgroup analyses were performed. Results Prophylactic indomethacin use varied by hospital. Treatment of a patent ductus arteriosus after the first day of life was less common among 2587 infants who received prophylactic indomethacin compared with 5244 who did not (21.0% vs 36.1%, P < .001). After adjustment for potential confounders, use of prophylactic indomethacin was not associated with higher or lower odds of BPD (OR 0.89, 95% CI 0.72-1.10), death (OR 0.80, 95% CI 0.64-1.01), or death or BPD (OR 0.87, 95% CI 0.71-1.05). The only evidence of subgroup effects associated with prophylactic indomethacin were lower odds of death among infants with birth weights above the 10th percentile and those who were not treated for a patent ductus arteriosus after the first day of life. Conclusions Prophylactic indomethacin was not associated with either reduced or increased risk for BPD or death. Trial registration ClinicalTrials.gov: NCT00063063

LanguageEnglish (US)
Pages34-40.e2
JournalJournal of Pediatrics
Volume186
DOIs
StatePublished - Jul 1 2017

Fingerprint

Extremely Premature Infants
Bronchopulmonary Dysplasia
Indomethacin
Patent Ductus Arteriosus
Birth Weight
National Institute of Child Health and Human Development (U.S.)
Gestational Age
Survivors
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Oxygen

Keywords

  • bronchopulmonary dysplasia
  • extreme prematurity
  • indomethacin
  • prophylaxis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2017). Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants. Journal of Pediatrics, 186, 34-40.e2. DOI: 10.1016/j.jpeds.2017.02.003

Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants. / Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

In: Journal of Pediatrics, Vol. 186, 01.07.2017, p. 34-40.e2.

Research output: Contribution to journalArticle

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network 2017, 'Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants' Journal of Pediatrics, vol. 186, pp. 34-40.e2. DOI: 10.1016/j.jpeds.2017.02.003
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants. Journal of Pediatrics. 2017 Jul 1;186:34-40.e2. Available from, DOI: 10.1016/j.jpeds.2017.02.003
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. / Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants. In: Journal of Pediatrics. 2017 ; Vol. 186. pp. 34-40.e2
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abstract = "Objective To assess the association between prophylactic indomethacin and bronchopulmonary dysplasia (BPD) in a recent, large cohort of extremely preterm infants. Study design Retrospective cohort study using prospectively collected data for infants with gestational ages < 29 weeks or birth weights of 401-1000 g born between 2008 and 2012 at participating hospitals of the National Institute of Child Health and Human Development Neonatal Research Network. Infants treated with indomethacin in the first 24 hours of life were compared with those who were not. Study outcomes were BPD, defined as use of supplemental oxygen at 36 weeks postmenstrual age among survivors to that time point, death, and the composite of death or BPD. Prespecified subgroup analyses were performed. Results Prophylactic indomethacin use varied by hospital. Treatment of a patent ductus arteriosus after the first day of life was less common among 2587 infants who received prophylactic indomethacin compared with 5244 who did not (21.0{\%} vs 36.1{\%}, P < .001). After adjustment for potential confounders, use of prophylactic indomethacin was not associated with higher or lower odds of BPD (OR 0.89, 95{\%} CI 0.72-1.10), death (OR 0.80, 95{\%} CI 0.64-1.01), or death or BPD (OR 0.87, 95{\%} CI 0.71-1.05). The only evidence of subgroup effects associated with prophylactic indomethacin were lower odds of death among infants with birth weights above the 10th percentile and those who were not treated for a patent ductus arteriosus after the first day of life. Conclusions Prophylactic indomethacin was not associated with either reduced or increased risk for BPD or death. Trial registration ClinicalTrials.gov: NCT00063063",
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T1 - Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants

AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

AU - Jensen,Erik A.

AU - Dysart,Kevin C.

AU - Gantz,Marie G.

AU - Carper,Benjamin

AU - Higgins,Rosemary D.

AU - Keszler,Martin

AU - Laughon,Matthew M.

AU - Poindexter,Brenda B.

AU - Stoll,Barbara J.

AU - Walsh,Michele C.

AU - Schmidt,Barbara

AU - Caplan,Michael S.

AU - Polin,Richard A.

AU - Laptook,Abbot R.

AU - Keszler,Martin

AU - Hensman,Angelita M.

AU - Basso,Kristin M.

AU - Vieira,Elisa

AU - Little,Emily

AU - Fanaroff,Avroy A.

AU - Hibbs,Anna Marie

AU - Newman,Nancy S.

AU - Truog,William E.

AU - Kilbride,Howard W.

AU - Pallotto,Eugenia K.

AU - Gauldin,Cheri

AU - Holmes,Anne

AU - Johnson,Kathy

AU - Knutson,Allison

AU - Schibler,Kurt

AU - Donovan,Edward F.

AU - Alexander,Barbara

AU - Grisby,Cathy

AU - Hessling,Jody

AU - Fischer,Estelle E.

AU - Jackson,Lenora D.

AU - Kirker,Kristin

AU - Muthig,Greg

AU - Goldberg,Ronald N.

AU - Cotten,C. Michael

AU - Fisher,Kimberley A.

AU - Auten,Kathy J.

AU - Foy,Katherine A.

AU - Grimes,Sandra

AU - Finkle,Joanne

AU - Laughon,Matthew M.

AU - Bose,Carl L.

AU - Bernhardt,Janice

AU - Bose,Gennie

AU - Carlton,David P.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective To assess the association between prophylactic indomethacin and bronchopulmonary dysplasia (BPD) in a recent, large cohort of extremely preterm infants. Study design Retrospective cohort study using prospectively collected data for infants with gestational ages < 29 weeks or birth weights of 401-1000 g born between 2008 and 2012 at participating hospitals of the National Institute of Child Health and Human Development Neonatal Research Network. Infants treated with indomethacin in the first 24 hours of life were compared with those who were not. Study outcomes were BPD, defined as use of supplemental oxygen at 36 weeks postmenstrual age among survivors to that time point, death, and the composite of death or BPD. Prespecified subgroup analyses were performed. Results Prophylactic indomethacin use varied by hospital. Treatment of a patent ductus arteriosus after the first day of life was less common among 2587 infants who received prophylactic indomethacin compared with 5244 who did not (21.0% vs 36.1%, P < .001). After adjustment for potential confounders, use of prophylactic indomethacin was not associated with higher or lower odds of BPD (OR 0.89, 95% CI 0.72-1.10), death (OR 0.80, 95% CI 0.64-1.01), or death or BPD (OR 0.87, 95% CI 0.71-1.05). The only evidence of subgroup effects associated with prophylactic indomethacin were lower odds of death among infants with birth weights above the 10th percentile and those who were not treated for a patent ductus arteriosus after the first day of life. Conclusions Prophylactic indomethacin was not associated with either reduced or increased risk for BPD or death. Trial registration ClinicalTrials.gov: NCT00063063

AB - Objective To assess the association between prophylactic indomethacin and bronchopulmonary dysplasia (BPD) in a recent, large cohort of extremely preterm infants. Study design Retrospective cohort study using prospectively collected data for infants with gestational ages < 29 weeks or birth weights of 401-1000 g born between 2008 and 2012 at participating hospitals of the National Institute of Child Health and Human Development Neonatal Research Network. Infants treated with indomethacin in the first 24 hours of life were compared with those who were not. Study outcomes were BPD, defined as use of supplemental oxygen at 36 weeks postmenstrual age among survivors to that time point, death, and the composite of death or BPD. Prespecified subgroup analyses were performed. Results Prophylactic indomethacin use varied by hospital. Treatment of a patent ductus arteriosus after the first day of life was less common among 2587 infants who received prophylactic indomethacin compared with 5244 who did not (21.0% vs 36.1%, P < .001). After adjustment for potential confounders, use of prophylactic indomethacin was not associated with higher or lower odds of BPD (OR 0.89, 95% CI 0.72-1.10), death (OR 0.80, 95% CI 0.64-1.01), or death or BPD (OR 0.87, 95% CI 0.71-1.05). The only evidence of subgroup effects associated with prophylactic indomethacin were lower odds of death among infants with birth weights above the 10th percentile and those who were not treated for a patent ductus arteriosus after the first day of life. Conclusions Prophylactic indomethacin was not associated with either reduced or increased risk for BPD or death. Trial registration ClinicalTrials.gov: NCT00063063

KW - bronchopulmonary dysplasia

KW - extreme prematurity

KW - indomethacin

KW - prophylaxis

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