Abstract
Objective Our objective was to examine changes in the use of indomethacin prophylaxis in the
neonatal intensive care unit (NICU) between 2008 and 2018.
Study Design The design of the study included cohort of 19,715 infants born between 220/7 and 266/7 weeks' gestation from 213 NICUs. A nonparametric trend test evaluated indomethacin
prophylaxis and the percentage of sites using any prophylaxis over time. We evaluated
the prevalence of indomethacin prophylaxis by the center and the correlation between
indomethacin prophylaxis and severe intraventricular hemorrhage prevalence among 12
centers with the largest relative change in indomethacin prophylaxis prevalence.
Results In total, 16% of infants received indomethacin prophylaxis. The use of indomethacin
prophylaxis did not significantly decrease between 2008 and 2018 but it significantly
decreased between 2014 and 2018 (p = 0.046). Among 74 centers with ≥10 infants included, 20% increased the use of indomethacin
prophylaxis, while 57% decreased the use over the study period. Of the 12 centers
with the largest relative change in indomethacin prophylaxis prevalence, 50% showed
an inverse correlation between indomethacin prophylaxis prevalence and severe intraventricular
hemorrhage, while 50% showed a positive correlation.
Conclusion Receipt of indomethacin prophylaxis remained similar until 2014, decreased from 2014
to 2018, and varied by the center.
Key Points
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The receipt of indomethacin prophylaxis decreased over time.
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Center change in the use of indomethacin prophylaxis does not correlate with the center
prevalence of IVH.
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Variability in the use of indomethacin prophylaxis across centers persists.
Keywords
indomethacin - neonates - intraventricular hemorrhage - prophylaxis
