Prophylactic indomethacin, antenatal betamethasone, and the risk of intestinal perforation in infants <28 weeks' gestation

J Perinatol. 2023 Oct;43(10):1252-1261. doi: 10.1038/s41372-023-01653-0. Epub 2023 Mar 27.

Abstract

Objective: To determine if intestinal perforations before 14 days (either spontaneous (SIP) or necrotizing enterocolitis-induced) are increased when infants who received antenatal betamethasone shortly before birth are treated with prophylactic indomethacin (PINDO).

Study design: Observational study of 475 infants <28 week's gestation assigned to either a PINDO-protocol (n = 231) or expectant management protocol (n = 244) during consecutive protocol epochs.

Results: Intestinal perforations before 14 days occurred in 33/475 (7%). In unadjusted and adjusted models, we found no associations between PINDO-protocol and intestinal perforations. PINDO-protocol did not increase intestinal perforations or SIP-alone even when given to infants who received betamethasone <7 or <2 days before delivery. 213/231 (92%) PINDO-protocol infants actually received indomethacin. The results were unchanged when examined just in those who received indomethacin.

Conclusion: In our study, early intestinal perforations and SIP-alone were not increased when PINDO was used by protocol in infants who received antenatal betamethasone shortly before birth.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Betamethasone / adverse effects
  • Enterocolitis, Necrotizing* / prevention & control
  • Female
  • Humans
  • Indomethacin / adverse effects
  • Infant
  • Infant, Newborn
  • Intestinal Perforation* / chemically induced
  • Pregnancy
  • Retrospective Studies

Substances

  • Indomethacin
  • Betamethasone