title: Effects of Prophylactic Indomethacin on Vasopressor-Dependent Hypotension in Extremely Preterm Infants.
abstract: To determine whether a moderate-to-large patent ductus arteriosus (PDA) is responsible for vasopressor-dependent hypotension, occurring at the end of the first postnatal week.
  
  
  
  We performed a retrospective, double cohort controlled study of infants delivered at ≤27+6weeks' gestation (n = 313). From January 2004 through April 2011, all infants were treated with prophylactic indomethacin ([PINDO] epoch). From May 2011 through December 2015, no infant was treated with indomethacin until at least 8 postnatal days (conservative epoch). Echocardiograms were performed on postnatal days 6 or 7. Hypotension was managed by a predefined protocol. The primary outcome was the incidence of dopamine-dependent hypotension, defined as having received at least 6 µg/kg/min dopamine for at least 24 hours during postnatal days 4-7.
  
  
  
  As expected, the incidence of moderate-to-large PDA at the end of the first week differed significantly between epochs (PINDO = 8%; conservative = 64%). In multivariate analyses, infants in the PINDO epoch had a significantly lower incidence of vasopressor-dependent hypotension (11%) than infants in the conservative epoch (21%; OR = 0.40, 95% CI 0.20-0.82). Infants in the PINDO epoch also required less mean airway pressure, had a lower respiratory severity score, and lower mode of ventilation score than infants in the conservative epoch during postnatal days 4-7. The effects of PINDO on both the incidence of vasopressor-dependent hypotension and the need for respiratory support were no longer significant when analyses were adjusted for "presence or absence of a moderate-to-large PDA."
  
  
  
  PINDO decreases vasopressor-dependent hypotension and the need for respiratory support at the end of the first postnatal week. These effects are mediated by closure of the PDA.
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, CA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Liebowitz
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, CA.
authors.forename: Jane
authors.initials: J
authors.lastname: Koo
authors.affiliation: Department of Pediatrics, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wickremasinghe
authors.affiliation: Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Isabel Elaine
authors.initials: IE
authors.lastname: Allen
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, CA; Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA. Electronic address: clymanr@peds.ucsf.edu.
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Clyman
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004298:Dopamine / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007213:Indomethacin / Q000627:therapeutic use*; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies
chemical_list: D002317:Cardiovascular Agents; D004298:Dopamine; D007213:Indomethacin
keywords: dopamine; hypotension; newborn; premature birth