ANTENATAL INDOMETHACIN - ADVERSE FETAL EFFECTS CONFIRMED

We examined the association between antenatal indomethacin exposure an d adverse neonatal outcome in a matched retrospective cohort study of infants born to 72 mothers at less than 31 weeks' gestation. Indometha cin-exposed mothers were matched to controls by gestational age at del ivery, antenatal corticosteroid exposure, prolonged spontaneous ruptur e of membranes, multiple pregnancy, thyrotrophin-releasing hormone (TR H) exposure, and neonatal sex. Periventricular haemorrhage was signifi cantly increased for infants delivered within 48 hours of maternal ind omethacin exposure (Grade 1 and 2 19% versus 6%, and Grades 3 and 4 28 % versus 3% (p<0.03)). Persistent patent ductus arteriosus was more co mmon in those infants delivered within 48 hours of maternal indomethac in exposure (40% versus 20% (p<0.04)). More neonates exposed to antena tal indomethacin failed to respond to postnatal indomethacin to close a patent ductus arteriosus, 60% versus 0% (p<0.04). There were no adve rse effects demonstrated of indomethacin administered greater than 48 hours from delivery. We have confirmed a probable association between antenatal indomethacin administration and an increased incidence of ne onatal periventricular haemorrhage, patent ductus arteriosus, and impa ired renal function, The adverse neonatal effects appear to be greates t when indomethacin is administered within 48 hours of delivery, We re commend that indomethacin should be used with caution as a tocolytic a gent for the treatment of preterm labour at gestations less than 31 we eks.