Prophylactic Indomethacin significantly decreases the incidence of a symptomatic PDA in ELBW infants (50% to 24%, p<0.001). Given early enough (<6 hours of age), prophylactic Indomethacin also decreases the incidence of severe (Grade III – IV) IVH (13% to 9%, p=0.02). However, prophylactic Indomethacin does not impact long-term outcome measures, either positively or negatively. (Schmidt. NEJM 2001; 344:1966-72.)

Candidates for prophylactic Indomethacin:

Of infants with a gestational age of < 34 weeks

• All AGA infants < 1000g birthweight

• Infants 1001 – 1250 g birthweight who require mechanical ventilation

Contraindication: Do not give prophylactic Indocin if Indomethacin was given to the mother as a tocolytic within 72 hours of delivery.

Qualifying Labs:

• Admission platelet count > 75,000 /mm³

• Serum Na⁺ and K⁺ within normal limits within 12 hours of dose

• Infant has voided

Dose:

• Indomethacin 0.2 mg/kg iv x 1 (given over 30 minutes; avoid using UAC)

• Give at 12 hours of age.

References:

Fowlie PW. Prophylactic intravenous indomethacin in very low birth weight infants. Cochrane Database of Systematic Reviews 2000; 2: CD000174. http://www.nichd.nih.gov/cochraneneonatal/FOWLIE/FOWLIE.HTM

Schmidt B, et al. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med 2001; 344: 1966-72.