P2C179: Incidence of Prematurity Comorbidities After Discontinuation of Prophylactic Indomethacin

Background: Early research pointed at the efficacy of prophylactic Indomethacin (PI) to treat patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH) and simultaneously described a side effect profile including oliguria, elevated creatinine (Cr) levels, necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP). Its efficacy for reduction of PDA, and severe grades of IVH does not appear to extend to NEC and bronchopulmonary dysplasia (BPD). Recent evidence regarding efficacy for IVH as well as the desire to implement alternative therapies for BPD and PDA led to a practice change in our level IV NICU with the discontinuation PI. This study aims to compare the incidence of BPD, PDA and IVH for infants born at ≤ 1250g before and after discontinuation of PI.

Methods: We conducted a retrospective review of N=118 charts of infants born at ≤ 1250g who were admitted to our NICU from 1/2020 to 8/2022. Infants were divided into 2 epochs: PI (1/2020-7/2021) and after PI discontinuation (8/2021-8/2022). Incidence of PDA, BPD and IVH, side effects and demographic data was compared and analyzed using SPSS.

Results: Of the 118 infants born during the 2 epochs, 68 received PI and 50 did not. Infants in epoch 1 had an average gestational age 25±1.8 weeks vs 28.8±2.1 (p=0.305) in epoch 2, and birthweight 772g±191 vs 1061.6g±192 (p=0.130). In epoch 1, the incidence of overall IVH was statistically significant with 41% compared to 24% (p=0.008) despite discontinuation of PI. Severity of IVH, incidence of PDA and BPD, PI adverse effects, and postnatal steroids, are denoted in Table 1. The incidence of PDA was also significantly increased at 31% vs 52% (p=0.05) after discontinuation of PI. The number of infants who received medical treatment of PDA rose during epoch 2, however of those treated, only 2 did not receive a diagnosis of BPD. Despite practice changes, the incidence of BPD (64% vs 62%) was not statistically significant including the use of postnatal steroids and home oxygen. This is in concordance with previously published studies that showed that PI reduces incidence of PDA and severe IVH but has not improve BPD outcomes significantly.

Conclusion: Our study shows that PI is associated with lower rates of PDA, higher rates of overall IVH and no significant effect on BPD incidence, requirement for dexamethasone for BPD management and need for oxygen support upon discharge. Infants exposed to PI had higher Cr levels but similar rates of NEC and SIP. Clinically, there appeared to be no adverse outcomes related to the practice change, though our study is limited by small sample size.