title: Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants.
abstract: To assess the association between prophylactic indomethacin and bronchopulmonary dysplasia (BPD) in a recent, large cohort of extremely preterm infants.
  
  
  
  Retrospective cohort study using prospectively collected data for infants with gestational ages < 29 weeks or birth weights of 401-1000 g born between 2008 and 2012 at participating hospitals of the National Institute of Child Health and Human Development Neonatal Research Network. Infants treated with indomethacin in the first 24 hours of life were compared with those who were not. Study outcomes were BPD, defined as use of supplemental oxygen at 36 weeks postmenstrual age among survivors to that time point, death, and the composite of death or BPD. Prespecified subgroup analyses were performed.
  
  
  
  Prophylactic indomethacin use varied by hospital. Treatment of a patent ductus arteriosus after the first day of life was less common among 2587 infants who received prophylactic indomethacin compared with 5244 who did not (21.0% vs 36.1%, P < .001). After adjustment for potential confounders, use of prophylactic indomethacin was not associated with higher or lower odds of BPD (OR 0.89, 95% CI 0.72-1.10), death (OR 0.80, 95% CI 0.64-1.01), or death or BPD (OR 0.87, 95% CI 0.71-1.05). The only evidence of subgroup effects associated with prophylactic indomethacin were lower odds of death among infants with birth weights above the 10th percentile and those who were not treated for a patent ductus arteriosus after the first day of life.
  
  
  
  Prophylactic indomethacin was not associated with either reduced or increased risk for BPD or death.
  
  
  
  ClinicalTrials.gov: NCT00063063.
authors.affiliation: Division of Neonatology and Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA. Electronic address: jensene@email.chop.edu.
authors.forename: Erik A
authors.initials: EA
authors.lastname: Jensen
authors.affiliation: Division of Neonatology and Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Dysart
authors.affiliation: Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC.
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.affiliation: Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Carper
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.affiliation: Department of Pediatrics, Brown University and Women and Infant's Hospital of Rhode Island, Providence, RI.
authors.forename: Martin
authors.initials: M
authors.lastname: Keszler
authors.affiliation: Department of Pediatrics, The University of North Carolina, Chapel Hill, NC.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Laughon
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Brenda B
authors.initials: BB
authors.lastname: Poindexter
authors.affiliation: University of Texas Health Science Center, McGovern Medical School, Houston, TX.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.affiliation: Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.affiliation: Division of Neonatology and Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schmidt
mesh_terms: D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D010102:Oxygen Inhalation Therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
keywords: bronchopulmonary dysplasia; extreme prematurity; indomethacin; prophylaxis