Prophylactic indomethacin infusion increases fractional cerebral oxygen extraction in ELBW neonates.
OBJECTIVE
Intraventricular hemorrhage (IVH) occurs in up to 25% of very low birth weight (VLBW) preterm neonates. Previous studies found that indomethacin administered in the first 6 h of life reduces the incidence of severe IVH in VLBW neonates and decreases cerebral blood flow, suggesting a decrease in cerebral oxygen delivery. Using near-infrared spectroscopy (NIRS), we monitored cerebral oxygenation before, during and after slow indomethacin infusion in extremely low birth weight (ELBW) neonates to determine whether indomethacin decreases cerebral oxygen saturation and increases cerebral oxygen extraction.


METHODS
Twenty-seven ELBW neonates less than 30 weeks gestational age treated with indomethacin for IVH prophylaxis were monitored for arterial oxygen saturation (SaO(2)) and NIRS-determined regional cerebral oxygen saturation (rSO(2)). At 30 to 60 s intervals, SaO(2), rSO(2) and mean arterial pressure (MAP) were recorded using a VitalSync. Average fractional cerebral oxygen extraction was calculated for the hour before indomethacin infusion, during the infusion and 2 h after infusion.


RESULTS
Fractional cerebral oxygen extraction increased from baseline after indomethacin administration from 0.23±0.11 to 0.25±0.10 (P=0.034).


CONCLUSIONS
Fractional cerebral oxygen extraction increased 9% with indomethacin 0.1 mg kg(-1) given over 1 to 2 h. However, the clinical implications of this small increase in extraction, likely representative of decreased cerebral perfusion, are unknown but may be harmful to the developing brain.
Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL 32610-0296, USA.
R S
RS
Garner
C
C
Miller
D J
DJ
Burchfield
D001921:Brain / Q000378:metabolism*; D002245:Carbon Dioxide / Q000097:blood; D002552:Cerebral Ventricles; D002560:Cerebrovascular Circulation / Q000187:drug effects; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007213:Indomethacin / Q000008:administration & dosage*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000517:prevention & control*; D008297:Male; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects*; D019265:Spectroscopy, Near-Infrared
D016861:Cyclooxygenase Inhibitors; D002245:Carbon Dioxide; D010100:Oxygen; D007213:Indomethacin