Indomethacin tocolysis and intraventricular hemorrhage.
OBJECTIVE
To determine the association between indomethacin tocolysis and neonatal intraventricular hemorrhage.


METHODS
Fifty-six preterm neonates with intraventricular hemorrhage were matched by gestational age with neonates (n = 224) without this morbidity. Maternal and neonatal charts were reviewed to ascertain the type of tocolytic exposure experienced by the neonate. Other maternal and neonatal demographic and outcome data were also abstracted. Results were analyzed using the Student t test, chi(2) analysis, and multivariable logistic regression. The number of studied subjects provided 80% power to determine if antenatal exposure to indomethacin was twice as likely among infants with intraventricular hemorrhage.


RESULTS
Univariate analysis revealed that there were no significant differences between the study and control groups with respect to maternal age, parity, or betamethasone exposure. Infants with intraventricular hemorrhage were significantly more likely to be born at an earlier gestational age, a lower birth weight, after maternal chorioamnionitis, after vaginal delivery, and after exposure to either indomethacin alone or a combination of indomethacin and magnesium. Additionally, their neonatal course was significantly more likely to be complicated by sepsis and respiratory distress syndrome. In a multivariable logistic model, only gestational age, chorioamnionitis, vaginal delivery, and respiratory distress syndrome continued to be significantly associated with intraventricular hemorrhage. Indomethacin exposure, either as single-agent (adjusted odds ratio 1.3, 95% confidence interval 0.5, 3.3) or combination tocolytic therapy (adjusted odds ratio 2.0, 95% confidence interval 0.8, 4.8), was not significantly associated with intraventricular hemorrhage.


CONCLUSIONS
Indomethacin tocolysis is not associated with an increased risk of intraventricular hemorrhage.
Suarez
R D
RD
Section of Maternal-Fetal Medicine and the Department of Obstetrics and Gynecology, Northwestern Memorial Hospital and Evanston Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
Grobman
W A
WA
Parilla
B V
BV
D000328:Adult; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D007213:Indomethacin / Q000008:administration & dosage / Q000009:adverse effects*; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016015:Logistic Models; D008274:Magnesium / Q000008:administration & dosage / Q000009:adverse effects; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012307:Risk Factors; D015145:Tocolysis / Q000009:adverse effects* / Q000379:methods; D014463:Ultrasonography
D000894:Anti-Inflammatory Agents, Non-Steroidal; D008274:Magnesium; D007213:Indomethacin