Comment

. 2021 Aug:235:26-33.e2.

doi: 10.1016/j.jpeds.2021.02.073. Epub 2021 Mar 7.

Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury

Collaborators, Affiliations

Collaborators

Canadian Neonatal Network investigators:
Marc Beltempo⁹, Jaideep Kanungo¹⁰, Joseph Ting¹¹, Zenon Cieslak¹², Rebecca Sherlock¹³, Ayman Abou Mehrem¹⁴, Jennifer Toye¹⁵, Carlos Fajardo¹⁶, Zarin Kalapesi¹⁷, Jaya Bodani¹⁷, Koravangattu Sankaran¹⁸, Lannae Strueby¹⁸, Mary Seshia¹⁹, Deepak Louis¹⁹, Ruben Alvaro²⁰, Amit Mukerji²¹, Orlando Da Silva²², Mohammad Adie²³, Kyong-Soon Lee²⁴, Eugene Ng²⁵, Brigitte Lemyre²⁶, Faiza Khurshid²⁷, Ermelinda Pelausa²⁸, Keith Barrington²⁹, Anie Lapoint²⁹, Guillaume Ethier²⁹, Christine Drolet³⁰, Martine Claveau³¹, Valerie Bertelle³², Edith Masse³², Roderick Canning³³, Hala Makary³⁴, Cecil Ojah³⁵, Luis Monterrosa³⁵, Julie Emberley³⁶, Andrzej Kajetanowicz³⁷, Shoo K Lee³⁸

Affiliations

¹ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
² Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
³ MiCare Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁴ Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
⁵ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
⁶ Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
⁷ Department of Pediatrics, Laval University, Quebec City, Quebec, Canada.
⁸ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. Electronic address: khalid.aziz@ualberta.ca.
⁹ Associate Director, Canadian Neonatal Network and Site Investigator, Montreal Children's Hospital at McGill University Health Centre, Montréal, Québec, Canada.
¹⁰ Victoria General Hospital, Victoria, British Columbia, Canada.
¹¹ B.C. Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
¹² Royal Columbian Hospital, New Westminster, British Columbia, Canada.
¹³ Surrey Memorial Hospital, Surrey, British Columbia, Canada.
¹⁴ Foothills Medical Centre, Calgary, Alberta, Canada.
¹⁵ Royal Alexandra Hospital, Edmonton, Alberta, Canada.
¹⁶ Alberta Children's Hospital, Calgary, Alberta, Canada.
¹⁷ Regina General Hospital, Regina, Saskatchewan, Canada.
¹⁸ Royal University Hospital, Saskatoon, Saskatchewan, Canada.
¹⁹ Winnipeg Health Sciences Centre, Winnipeg, Manitoba, Canada.
²⁰ St Boniface General Hospital, Winnipeg, Manitoba, Canada.
²¹ Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.
²² London Health Sciences Centre, London, Ontario, Canada.
²³ Windsor Regional Hospital, Windsor, Ontario, Canada.
²⁴ Hospital for Sick Children, Toronto, Ontario, Canada.
²⁵ Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
²⁶ Children's Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario, Canada.
²⁷ Kingston General Hospital, Kingston, Ontario, Canada.
²⁸ Jewish General Hospital, Montréal, Québec, Canada.
²⁹ Hôpital Sainte-Justine, Montréal, Québec, Canada.
³⁰ Centre Hospitalier Universitaire de Québec, Sainte Foy, Québec, Canada.
³¹ Montreal Children's Hospital at McGill University Health Centre, Montréal, Québec, Canada.
³² Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
³³ Moncton Hospital, Moncton, New Brunswick, Canada.
³⁴ Dr Everett Chalmers Hospital, Fredericton, New Brunswick, Canada.
³⁵ Saint John Regional Hospital, Saint John, New Brunswick, Canada.
³⁶ Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland, Canada.
³⁷ Cape Breton Regional Hospital, Sydney, Nova Scotia, Canada.
³⁸ Chairman, Canadian Neonatal Network, Mount Sinai Hospital, Toronto, Ontario, Canada.

PMID: 33689709
DOI: 10.1016/j.jpeds.2021.02.073

Comment

Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury

Mosarrat Qureshi et al. J Pediatr. 2021 Aug.

. 2021 Aug:235:26-33.e2.

doi: 10.1016/j.jpeds.2021.02.073. Epub 2021 Mar 7.

Collaborators

Canadian Neonatal Network investigators:
Marc Beltempo⁹, Jaideep Kanungo¹⁰, Joseph Ting¹¹, Zenon Cieslak¹², Rebecca Sherlock¹³, Ayman Abou Mehrem¹⁴, Jennifer Toye¹⁵, Carlos Fajardo¹⁶, Zarin Kalapesi¹⁷, Jaya Bodani¹⁷, Koravangattu Sankaran¹⁸, Lannae Strueby¹⁸, Mary Seshia¹⁹, Deepak Louis¹⁹, Ruben Alvaro²⁰, Amit Mukerji²¹, Orlando Da Silva²², Mohammad Adie²³, Kyong-Soon Lee²⁴, Eugene Ng²⁵, Brigitte Lemyre²⁶, Faiza Khurshid²⁷, Ermelinda Pelausa²⁸, Keith Barrington²⁹, Anie Lapoint²⁹, Guillaume Ethier²⁹, Christine Drolet³⁰, Martine Claveau³¹, Valerie Bertelle³², Edith Masse³², Roderick Canning³³, Hala Makary³⁴, Cecil Ojah³⁵, Luis Monterrosa³⁵, Julie Emberley³⁶, Andrzej Kajetanowicz³⁷, Shoo K Lee³⁸

Affiliations

¹ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
² Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
³ MiCare Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁴ Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
⁵ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
⁶ Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
⁷ Department of Pediatrics, Laval University, Quebec City, Quebec, Canada.
⁸ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. Electronic address: khalid.aziz@ualberta.ca.
⁹ Associate Director, Canadian Neonatal Network and Site Investigator, Montreal Children's Hospital at McGill University Health Centre, Montréal, Québec, Canada.
¹⁰ Victoria General Hospital, Victoria, British Columbia, Canada.
¹¹ B.C. Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
¹² Royal Columbian Hospital, New Westminster, British Columbia, Canada.
¹³ Surrey Memorial Hospital, Surrey, British Columbia, Canada.
¹⁴ Foothills Medical Centre, Calgary, Alberta, Canada.
¹⁵ Royal Alexandra Hospital, Edmonton, Alberta, Canada.
¹⁶ Alberta Children's Hospital, Calgary, Alberta, Canada.
¹⁷ Regina General Hospital, Regina, Saskatchewan, Canada.
¹⁸ Royal University Hospital, Saskatoon, Saskatchewan, Canada.
¹⁹ Winnipeg Health Sciences Centre, Winnipeg, Manitoba, Canada.
²⁰ St Boniface General Hospital, Winnipeg, Manitoba, Canada.
²¹ Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.
²² London Health Sciences Centre, London, Ontario, Canada.
²³ Windsor Regional Hospital, Windsor, Ontario, Canada.
²⁴ Hospital for Sick Children, Toronto, Ontario, Canada.
²⁵ Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
²⁶ Children's Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario, Canada.
²⁷ Kingston General Hospital, Kingston, Ontario, Canada.
²⁸ Jewish General Hospital, Montréal, Québec, Canada.
²⁹ Hôpital Sainte-Justine, Montréal, Québec, Canada.
³⁰ Centre Hospitalier Universitaire de Québec, Sainte Foy, Québec, Canada.
³¹ Montreal Children's Hospital at McGill University Health Centre, Montréal, Québec, Canada.
³² Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
³³ Moncton Hospital, Moncton, New Brunswick, Canada.
³⁴ Dr Everett Chalmers Hospital, Fredericton, New Brunswick, Canada.
³⁵ Saint John Regional Hospital, Saint John, New Brunswick, Canada.
³⁶ Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland, Canada.
³⁷ Cape Breton Regional Hospital, Sydney, Nova Scotia, Canada.
³⁸ Chairman, Canadian Neonatal Network, Mount Sinai Hospital, Toronto, Ontario, Canada.

PMID: 33689709
DOI: 10.1016/j.jpeds.2021.02.073

Abstract

Objective: To evaluate the impact of prophylactic indomethacin on early death (<10 days after birth) or severe neurologic injury and on early death or spontaneous intestinal perforation by completed weeks of gestational age in neonates born <29 weeks of gestation.

Study design: This was a multicenter, retrospective cohort study of neonates (n = 12 515) born at 23^6/7 weeks of gestational age, admitted to neonatal intensive care units participating in the Canadian Neonatal Network who received prophylactic indomethacin started within the first 12 hours after birth. Univariate and multivariate analysis compared the composite outcomes of early death or severe neurologic injury and early death or spontaneous intestinal perforation.

Results: Of 12 515 eligible neonates, 1435 (11.5%) were exposed to prophylactic indomethacin; recipients were of lower gestational age and birth weight and had greater severity of illness (Score of Neonatal Acute Physiology with Perinatal Extension) on admission compared with nonrecipients. After we adjusted for confounders, prophylactic indomethacin was associated with reduced odds of early death or severe neurologic injury and early death or spontaneous intestinal perforation in neonates born at 23-24 weeks of gestational age. However, prophylactic indomethacin was associated with increased odds of early mortality or spontaneous intestinal perforation for neonates born at 26-28 weeks of gestational age.

Conclusions: Prophylactic indomethacin use was associated with benefit in neonates born at 23-24 weeks of gestational age, but with harm at 26-28 weeks of gestational age. Given the observation of significantly improved survival, a randomized controlled trial is needed to investigate the effect of prophylactic indomethacin in babies born at 23-25 weeks of gestational age.

Keywords: necrotizing enterocolitis; preterm infants; severe neurologic injury; spontaneous intestinal perforation.

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Comment in

Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation.
Kandraju H, Kanungo J, Lee KS, Daspal S, Adie MA, Dorling J, Ye XY, Lee SK, Shah PS; Canadian Neonatal Network (CNN); Canadian Preterm Birth Network (CPTBN) Investigators. Kandraju H, et al. J Pediatr. 2021 Aug;235:34-41.e1. doi: 10.1016/j.jpeds.2021.03.012. Epub 2021 Mar 16. J Pediatr. 2021. PMID: 33741365
Neonatal Network Data Based‒Associations Based on Large Numbers that May Be Spurious.
Jobe AH. Jobe AH. J Pediatr. 2021 Aug;235:18-19. doi: 10.1016/j.jpeds.2021.04.013. Epub 2021 Apr 13. J Pediatr. 2021. PMID: 33862024 No abstract available.

Comment on

Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation.
Kandraju H, Kanungo J, Lee KS, Daspal S, Adie MA, Dorling J, Ye XY, Lee SK, Shah PS; Canadian Neonatal Network (CNN); Canadian Preterm Birth Network (CPTBN) Investigators. Kandraju H, et al. J Pediatr. 2021 Aug;235:34-41.e1. doi: 10.1016/j.jpeds.2021.03.012. Epub 2021 Mar 16. J Pediatr. 2021. PMID: 33741365
Neonatal Network Data Based‒Associations Based on Large Numbers that May Be Spurious.
Jobe AH. Jobe AH. J Pediatr. 2021 Aug;235:18-19. doi: 10.1016/j.jpeds.2021.04.013. Epub 2021 Apr 13. J Pediatr. 2021. PMID: 33862024 No abstract available.

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Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury

Collaborators

Affiliations

Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury

Authors

Collaborators

Affiliations

Abstract

Comment in

Comment on

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LinkOut - more resources

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