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 m atched by gestational age with neonates (n = 224) without this morbidity. M aternal and neonatal charts were reviewed to ascertain the type of tocolyti c exposure experienced by the neonate. Other maternal and neonatal demograp hic and outcome data were also abstracted. Results were analyzed using the Student t test, chi (2) analysis, and multivariable logistic regression. Th e number of studied subjects provided 80% power to determine if antenatal e xposure to indomethacin was twice as likely among infants with intraventric ular hemorrhage. Results: Univariate analysis revealed that there were no significant differ ences between the study and control groups with respect to maternal age, pa rity, or betamethasone exposure. Infants with intraventricular hemorrhage w ere significantly more likely to be born at an earlier gestational age, a l ower birth weight, after maternal chorioamnionitis, after vaginal delivery, and after exposure to either indomethacin alone or a combination of indome thacin 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 signif icantly 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% con fidence interval 0.8, 4.8), was not significantly associated with intravent ricular hemorrhage. Conclusion: Indomethacin tocolysis is not associated with an increased risk of intraventricular hemorrhage. (Obstet Gynecol 2001;97:921-5. (C) 2000 by The American College of Obstetricians and Gynecologists.).