Indomethacin Prophylaxis in Preterm Infants: Changes over Time

Am J Perinatol. 2024 May;41(S 01):e680-e688. doi: 10.1055/a-1925-5173. Epub 2022 Aug 16.


Objective: Our objective was to examine changes in the use of indomethacin prophylaxis in the neonatal intensive care unit (NICU) between 2008 and 2018.

Study design: The design of the study included cohort of 19,715 infants born between 220/7 and 266/7 weeks' gestation from 213 NICUs. A nonparametric trend test evaluated indomethacin prophylaxis and the percentage of sites using any prophylaxis over time. We evaluated the prevalence of indomethacin prophylaxis by the center and the correlation between indomethacin prophylaxis and severe intraventricular hemorrhage prevalence among 12 centers with the largest relative change in indomethacin prophylaxis prevalence.

Results: In total, 16% of infants received indomethacin prophylaxis. The use of indomethacin prophylaxis did not significantly decrease between 2008 and 2018 but it significantly decreased between 2014 and 2018 (p = 0.046). Among 74 centers with ≥10 infants included, 20% increased the use of indomethacin prophylaxis, while 57% decreased the use over the study period. Of the 12 centers with the largest relative change in indomethacin prophylaxis prevalence, 50% showed an inverse correlation between indomethacin prophylaxis prevalence and severe intraventricular hemorrhage, while 50% showed a positive correlation.

Conclusion: Receipt of indomethacin prophylaxis remained similar until 2014, decreased from 2014 to 2018, and varied by the center.Key Points · The receipt of indomethacin prophylaxis decreased over time.. · Center change in the use of indomethacin prophylaxis does not correlate with the center prevalence of IVH.. · Variability in the use of indomethacin prophylaxis across centers persists..

Publication types

  • Multicenter Study

MeSH terms

  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / prevention & control
  • Cerebral Intraventricular Hemorrhage / epidemiology
  • Cerebral Intraventricular Hemorrhage / prevention & control
  • Female
  • Gestational Age
  • Humans
  • Indomethacin* / therapeutic use
  • Infant, Extremely Premature
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / epidemiology
  • Infant, Premature, Diseases / prevention & control
  • Intensive Care Units, Neonatal*
  • Male


  • Indomethacin