Indomethacin for prevention of neonatal intraventricular hemorrhage

Up to 50 percent of premature infants develop an intracerebral hemorrhage. Intracerebral hemorrhage in neonates occurs most frequently in the periventricular or intraventricular areas. Intravascular, vascular, and extravascular factors influence the development of hemorrhage. Pharmacologic therapies, such as phenobarbital, vitamin K, pancuronium bromide, vitamin E, and indomethacin, have been used in an attempt to prevent intraventricular hemorrhage (IH). Indomethacin inhibits prostaglandin production, which results in cerebral vasoconstriction and reduced cerebral blood flow. Several clinical studies have evaluated the role of indomethacin for the prevention of IH in premature infants. No definitive recommendations can be made regarding indomethacin use for this purpose. However, the two largest studies conducted to date have shown indomethacin to be effective in preventing or limiting the progression of IH. The drug appears to be most effective in reducing low-grade IH. More extensive research is needed to determine the most effective dose, duration, and serum concentration of indomethacin.