Indomethacin as IVH Prophylaxis???

[newgradRN001]

We had a 23 weeker on our unit and an MD prescribed two rounds of Indomethacin as a prophylais for IVH for this kiddo. I read the research that was done in 1988 and I wasn't completely convinced by the research article on the validity of Indocin as prophylaxis for IVH. I certainly did not feel that is showed enough evidence to base clinical practice on. Of course the kid that got the multiple rounds of Indocin perfed, but I have to say, hasn't had IVH. Does anyone else use Indomethacin on their unit as prophylaxis for IVH? Does anyone know of more research or has a more solid understanding of why Indocin should be used a prophylaxis for IVH? The research article did mention that Indocin causes reduced blood flow to the brain, there-by reducing pressures and decreasing risk and incidence of IVH. But at what cost and really how effectively? Effectively enough to risk perfing? Thoughts????

[JGriffin]

Hello!

We actually do use Indocin prophylaxis. I think the key is not initiating feeds while you are giving the indocin and sticking with the regimented schedule of at least 12 hours between dosing. It is also crucial to give it slowly. Here are a few recent articles.

http://www.nature.com/jp/journal/v23/n4/full/7210893a.

htmlhttp://www.ncbi.nlm.nih.gov/pubmed/15235161

http://pediatrics.aappublications.org/content/98/4/784.abstract

[helicoptergal, BSN, RN]

We also use Indocin as a IVH prophylaxis. In my own experience the 2 patients I have been involved with receiving it both had isolated ileal perforation, both had a pen rose drain inserted and antibiotics, but did well. And did not have IVH.

[nicurn09]

We have been using Indocin prophylaxis or IVH for about a year and a haf now with our micropremies. We have seen some decrease in the incidence and severity of IVH in these kiddos. I can't really think of any kids that have really had severe IVH since we have started the prophylaxis, except for one who was a transport from a very rural hospital with a really bad delivery so it could have already been there. However, we have seen slight increase in out NEC rates and perforations.

[Bortaz, MSN, RN]

We recently started this, and despite much evidence to the contrary, our lead neo continues to deny a correlation between the indocin and the perfs we're seeing. Frustrates me.