In April 1994, Ment et al reported results of a multicenter randomized trial indicating that low dose indomethacin initiated within the first 12 hours of life reduced the incidence and severity of intraventricular hemorrhage (IVH) in infants 501-1250 g. Subsequently the use of indomethacin increased within the NICHD Neonatal Research Network (NRN) Centers. We compared the frequency of IVH in ELBW infants (birthweight 501-1000 g) born 1/01/95-12/31/95 (n=985) who received indomethacin (35%) and who did not receive indomethacin (65%) within 24 hours of birth. Data were collected prospectively on maternal and infant conditions for all very low birthweight infants cared for within the NRN Centers. Multivariant analyses adjusting for birthweight, gestational age, hypertension, preeclampsia, cesarean section, gender, race, antenatal steroid and indomethacin were used to calculate the adjusted odds ratios (OR) for the effect of indomethacin on IVH. Analyses were performed for all IVH, grade III-IV IVH, and proven (grade II-III) necrotizing enterocolitis (NEC). Table

Table 1

A significant decrease in all IVH and in grade III-IV IVH was observed with indomethacin use within the first 24 hours of age in the extremely low birthweight population. There was no significant effect of indomethacin on the incidence of proven NEC. Although these data support the use of indomethacin for prevention of IVH in the extremely low birthweight infant, long-term safety and benefit remain to be determined.