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Prophylactic indomethacin infusion increases fractional cerebral oxygen extraction in ELBW neonates

Journal of Perinatology volume 32, pages 695–698 (2012)Cite this article

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Abstract

Objective:

Intraventricular hemorrhage (IVH) occurs in up to 25% of very low birth weight (VLBW) preterm neonates. Previous studies found that indomethacin administered in the first 6 h of life reduces the incidence of severe IVH in VLBW neonates and decreases cerebral blood flow, suggesting a decrease in cerebral oxygen delivery. Using near-infrared spectroscopy (NIRS), we monitored cerebral oxygenation before, during and after slow indomethacin infusion in extremely low birth weight (ELBW) neonates to determine whether indomethacin decreases cerebral oxygen saturation and increases cerebral oxygen extraction.

Study Design:

Twenty-seven ELBW neonates less than 30 weeks gestational age treated with indomethacin for IVH prophylaxis were monitored for arterial oxygen saturation (SaO2) and NIRS-determined regional cerebral oxygen saturation (rSO2). At 30 to 60 s intervals, SaO2, rSO2 and mean arterial pressure (MAP) were recorded using a VitalSync. Average fractional cerebral oxygen extraction was calculated for the hour before indomethacin infusion, during the infusion and 2 h after infusion.

Result:

Fractional cerebral oxygen extraction increased from baseline after indomethacin administration from 0.23±0.11 to 0.25±0.10 (P=0.034).

Conclusion:

Fractional cerebral oxygen extraction increased 9% with indomethacin 0.1 mg kg−1 given over 1 to 2 h. However, the clinical implications of this small increase in extraction, likely representative of decreased cerebral perfusion, are unknown but may be harmful to the developing brain.

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Acknowledgements

We thank the American Heart Association for their grant support of this project (09CRP2040000). In addition, we thank Somanetics Corporation for providing us with the research equipment essential to completing this study. This study was supported by a grant from the American Heart Association and an in-kind grant from Somanetics Corporation.

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  1. Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA

    R S Garner, C Miller & D J Burchfield

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  1. R S Garner
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  2. C Miller
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  3. D J Burchfield
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Correspondence to D J Burchfield.

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Competing interests

Dr Garner's work has been funded by the American Heart Association. Dr Burchfield has received compensation as a member of the scientific advisory board of Covidien. Mrs Miller declares no conflict of interest.

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Garner, R., Miller, C. & Burchfield, D. Prophylactic indomethacin infusion increases fractional cerebral oxygen extraction in ELBW neonates. J Perinatol 32, 695–698 (2012). https://doi.org/10.1038/jp.2011.175

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