TY - JOUR
T1 - Model for severe intracranial hemorrhage and role of early indomethacin in extreme preterm infants
AU - for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
AU - Chawla, Sanjay
AU - Natarajan, Girija
AU - Laptook, Abbot R.
AU - Chowdhury, Dhuly
AU - Bell, Edward F.
AU - Ambalavanan, Namasivayam
AU - Carlo, Waldemar A.
AU - Gantz, Marie
AU - Das, Abhik
AU - Tapia, Jose L.
AU - Harmon, Heidi M.
AU - Shankaran, Seetha
N1 - Funding Information:
This study is supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
PY - 2022/12
Y1 - 2022/12
N2 - Background: To develop a model for prediction of severe intracranial hemorrhage (ICH) or death based on variables from the first 12 h of age and to compare mortality and morbidities with and without exposure to early indomethacin. Methods: This retrospective cohort study included extreme preterm (220/7−266/7 weeks) infants born at National Institute of Child Health and Human Development Neonatal Research Network sites. Primary outcome was a composite of severe ICH and/or death. Results: Of 4624 infants, 1827 received early indomethacin. Lower gestation, lack of antenatal steroids exposure, lower 1-min Apgar, male sex, and receipt of epinephrine were associated with severe ICH or death. Early indomethacin was associated with a lower risk of patent ductus arteriosus, bronchopulmonary dysplasia, and higher risk of spontaneous intestinal perforation. Conclusions: A model for early prediction of severe ICH/death was developed and validated. Early indomethacin was associated with a lower risk of patent ductus arteriosus and bronchopulmonary dysplasia and a higher risk of spontaneous intestinal perforation. Clinical trial registration: Not applicable. Impact: Modern data on severe ICH and neonatal morbidities in relation to prophylactic indomethacin are scarce in the published literature.Prophylactic indomethacin was associated with a lower risk of patent ductus arteriosus and bronchopulmonary dysplasia and a higher risk of intestinal perforation.A risk estimator for severe intracranial hemorrhage/death was developed in a large cohort of extremely preterm infants.The risk estimator developed based on a large cohort of patients provides an estimate of severe intracranial bleeding for an individual infant.
AB - Background: To develop a model for prediction of severe intracranial hemorrhage (ICH) or death based on variables from the first 12 h of age and to compare mortality and morbidities with and without exposure to early indomethacin. Methods: This retrospective cohort study included extreme preterm (220/7−266/7 weeks) infants born at National Institute of Child Health and Human Development Neonatal Research Network sites. Primary outcome was a composite of severe ICH and/or death. Results: Of 4624 infants, 1827 received early indomethacin. Lower gestation, lack of antenatal steroids exposure, lower 1-min Apgar, male sex, and receipt of epinephrine were associated with severe ICH or death. Early indomethacin was associated with a lower risk of patent ductus arteriosus, bronchopulmonary dysplasia, and higher risk of spontaneous intestinal perforation. Conclusions: A model for early prediction of severe ICH/death was developed and validated. Early indomethacin was associated with a lower risk of patent ductus arteriosus and bronchopulmonary dysplasia and a higher risk of spontaneous intestinal perforation. Clinical trial registration: Not applicable. Impact: Modern data on severe ICH and neonatal morbidities in relation to prophylactic indomethacin are scarce in the published literature.Prophylactic indomethacin was associated with a lower risk of patent ductus arteriosus and bronchopulmonary dysplasia and a higher risk of intestinal perforation.A risk estimator for severe intracranial hemorrhage/death was developed in a large cohort of extremely preterm infants.The risk estimator developed based on a large cohort of patients provides an estimate of severe intracranial bleeding for an individual infant.
UR - http://www.scopus.com/inward/record.url?scp=85126788456&partnerID=8YFLogxK
U2 - 10.1038/s41390-022-02012-z
DO - 10.1038/s41390-022-02012-z
M3 - Article
C2 - 35301420
AN - SCOPUS:85126788456
VL - 92
SP - 1648
EP - 1656
JO - Pediatric Research
JF - Pediatric Research
SN - 0031-3998
IS - 6
ER -