Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants

John Kelleher; Ariel A Salas; Ramachandra Bhat; Namasivayam Ambalavanan; Shampa Saha; Barbara J Stoll; Edward F Bell; Michele C Walsh; Abbot R Laptook; Pablo J Sánchez; Seetha Shankaran; Krisa P VanMeurs; Ellen C Hale; Nancy S Newman; M Bethany Ball; Abhik Das; Rosemary D Higgins; Myriam Peralta-Carcelen; Waldemar A Carlo; GDB Subcommittee, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1542/peds.2014-0183

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Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants

Journal article

Open access

Peer reviewed

Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants

John Kelleher, Ariel A Salas, Ramachandra Bhat, Namasivayam Ambalavanan, Shampa Saha, Barbara J Stoll, Edward F Bell, Michele C Walsh, Abbot R Laptook, Pablo J Sánchez, …

Pediatrics (Evanston), Vol.134(5), pp.e1369-e1377

11/2014

DOI: 10.1542/peds.2014-0183

PMCID: PMC4533280

PMID: 25349317

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Abstract

Prophylactic indomethacin reduces severe intraventricular hemorrhage but may increase spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants. Early feedings improve nutritional outcomes but may increase the risk of SIP. Despite their benefits, use of these therapies varies largely by physician preferences in part because of the concern for SIP. This was a cohort study of 15,751 ELBW infants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 1999 to 2010 who survived beyond 12 hours after birth. The risk of SIP was compared between groups of infants with and without exposure to prophylactic indomethacin and early feeding in unadjusted analyses and in analyses adjusted for center and for risks of SIP. Among infants exposed to prophylactic indomethacin, the risk of SIP did not differ between the indomethacin/early-feeding group compared with the indomethacin/no-early-feeding group (adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.49-1.11). The risk of SIP was lower in the indomethacin/early-feeding group compared with the no indomethacin/no-early-feeding group (adjusted RR 0.58, 95% CI 0.37-0.90, P = .0159). Among infants not exposed to indomethacin, early feeding was associated with a lower risk of SIP compared with the no early feeding group (adjusted RR 0.53, 95% CI 0.36-0.777, P = .0011). The combined or individual use of prophylactic indomethacin and early feeding was not associated with an increased risk of SIP in ELBW infants.

Infant, Extremely Low Birth Weight - growth & development

Prospective Studies

Follow-Up Studies

Humans

Female

Male

Retrospective Studies

Indomethacin - administration & dosage

Intestinal Perforation - diagnosis

Infant, Newborn

Intestinal Perforation - prevention & control

Cohort Studies

Details

Title: Subtitle: Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants
Creators: John Kelleher - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Ariel A Salas - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Ramachandra Bhat - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Namasivayam Ambalavanan - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Shampa Saha - Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
Barbara J Stoll - Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, Georgia
Edward F Bell - Department of Pediatrics, University of Iowa, Iowa City, Iowa
Michele C Walsh - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
Abbot R Laptook - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
Pablo J Sánchez - Department of Pediatrics, Women & Infants' Hospital, Brown University, Providence, Rhode Island
Seetha Shankaran - Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
Krisa P VanMeurs - Department of Pediatrics, Wayne State University, Detroit, Michigan
Ellen C Hale - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Nancy S Newman - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
M Bethany Ball - Department of Pediatrics, Wayne State University, Detroit, Michigan
Abhik Das - Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; and
Rosemary D Higgins - Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland
Myriam Peralta-Carcelen - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Waldemar A Carlo - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; wcarlo@peds.uab.edu
GDB Subcommittee, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.134(5), pp.e1369-e1377
DOI: 10.1542/peds.2014-0183
PMID: 25349317
PMCID: PMC4533280
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Publisher: American Academy of Pediatrics
Grant note: UG1 HD053089 / NICHD NIH HHS U10 HD27856 / NICHD NIH HHS M01 RR997 / NCRR NIH HHS M01 RR16587 / NCRR NIH HHS U10 HD53089 / NICHD NIH HHS NCRR UL1024160 / PHS HHS U10 HD027871 / NICHD NIH HHS U10 HD27880 / NICHD NIH HHS M01 RR008084 / NCRR NIH HHS M01 RR016587 / NCRR NIH HHS U10 HD040498 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS M01 RR39 / NCRR NIH HHS M01 RR7122 / NCRR NIH HHS U10 HD040521 / NICHD NIH HHS U10 HD27853 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS M01 RR70 / NCRR NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD36790 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS M01 RR8084 / NCRR NIH HHS U10HD21415 / NICHD NIH HHS U10 HD40498 / NICHD NIH HHS M01 RR64 / NCRR NIH HHS M01 RR44 / NCRR NIH HHS UL1 RR24139 / NCRR NIH HHS U10 HD40492 / NICHD NIH HHS M01 RR007122 / NCRR NIH HHS U10 HD021385 / NICHD NIH HHS U10 HD040461 / NICHD NIH HHS U10 HD53119 / NICHD NIH HHS U10 HD053124 / NICHD NIH HHS M01 RR80 / NCRR NIH HHS U10 HD34216 / NICHD NIH HHS U10 HD27851 / NICHD NIH HHS M01RR59 / NCRR NIH HHS U10 HD053119 / NICHD NIH HHS M01 RR125 / NCRR NIH HHS U10HD27871 / NICHD NIH HHS M01 RR006022 / NCRR NIH HHS U10 HD53109 / NICHD NIH HHS U10 HD21397 / NICHD NIH HHS U10 HD021397 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS UL1 RR024139 / NCRR NIH HHS U10 HD21364 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS (U10 HD27904 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD40689 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS U10 HD40461 / NICHD NIH HHS U10 HD21385 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS M01 RR633 / NCRR NIH HHS M01 RR750 / NCRR NIH HHS U10 HD034216 / NICHD NIH HHS M01 RR6022 / NCRR NIH HHS U10 HD40521 / NICHD NIH HHS M01RR32 / NCRR NIH HHS U10 HD21373 / NICHD NIH HHS U10 HD27881 / NICHD NIH HHS M01 RR30 / NCRR NIH HHS M01 RR54 / NCRR NIH HHS U10 HD53124 / NICHD NIH HHS
Language: English
Date published: 11/2014
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093316602771

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