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Tocolytic indomethacin: effects on neonatal haemodynamics and cerebral autoregulation in the preterm newborn
  1. Willem Baerts1,
  2. Frank van Bel1,
  3. Liesbeth Thewissen2,
  4. Jan B Derks3,
  5. Petra MA Lemmers1
  1. 1Department of Neonatology, Utrecht University Medical Center, Utrecht, The Netherlands
  2. 2Neonatal Intensive Care Unit, Leuven University Hospitals, Leuven, Belgium
  3. 3Department of Obstetrics, Utrecht University Medical Center, Utrecht, The Netherlands
  1. Correspondence to Dr Willem Baerts, Department of Neonatology, University Medical Center Utrecht, room KH03.419.1, Wilhelmina Children's Hospital, Lundlaan 6, Utrecht 3584 EA, The Netherlands; w.baerts{at}umcutrecht.nl

Abstract

Background Indomethacin has vasoactive properties in cerebral and systemic vascular beds, and it improves cerebral autoregulatory ability. We speculated that tocolytic indomethacin will improve cerebral autoregulatory ability in the very preterm infant in early postnatal life.

Methods Eighteen stable preterm infants gestational age (GA) 25.3–29.6 weeks, birth weight (BW) 660–1430 grams), whose mothers had received 50–150 mg of tocolytic indomethacin within 24 h before birth, and 18 individually matched controls (GA 25.0–29.7 weeks, BW 700–1390 grams) were studied four times for 15 min in the first 24 h of life. Autoregulation was assessed by determining correlations between mean arterial blood pressure (MABP (mm Hg)) and near-infrared spectroscopy-monitored cerebral oxygenation (rScO2).

Results MABPs were significantly higher in the indomethacin infants than in the control infants (p=0.03). A decreased ability to autoregulate was found in four of the indomethacin infants, and in six of the control infants, which is not significantly different.

Conclusions Prenatally administered indomethacin, given as a tocolytic in doses of 50–150 mg per day, improved transitional circulation in very preterm infants by significantly raising the MABP. It did not have an effect on the ability to autoregulate the cerebral circulation. In this study, no differences in short-term outcomes, like haemorrhagic or ischaemic cerebral lesions, were observed.

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