Objective: To determine the risk of persistent renal insufficiency (RI) in premature infants following the use of antenatal indomethacin for suppression of preterm labor.
Study design: This population-based, retrospective review consisted of infants admitted during a 5-year period (1994-1999) to a tertiary referral neonatal intensive care nursery. Data were reviewed on 37 infants whose mothers received indomethacin for tocolysis, and on 37 matched controls. Renal insufficiency was defined as infant creatinine (Cr) > or = 1.5 mg/dl (133 micromol/l) for > or = 1 day.
Results: Infants whose mothers had received indomethacin for tocolysis were more likely than matched controls to have RI (9 of 37 vs 2 of 37, p = 0.04). Among infants of indomethacin-treated mothers with elevated Cr, serum Cr remained > or = 1.5 mg/dl (133 micromol/l) for a median of 6 days and > 1.0 mg/dl (88 micromol/l) for a median of 19 days. The peak Cr and length of elevation were closely correlated (r(2) = 0.63, p < 0.0001).
Conclusion: Antenatal indomethacin can result in significant, prolonged RI in the infant. It may pose important risks to renal function and homeostasis in premature infants.