Indomethacin may prevent brain injury in premature infants

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The results of a magnetic resonance imaging (MRI) study suggest that indomethacin may reduce the extent of white matter lesions in the brains of premature infants, researchers report in the May issue of Pediatrics.

"Our findings support other observations that inflammation may play a role in white matter injury of prematurity," lead author Dr. Steven P. Miller told Reuters Health. "These observations also highlight the promise of MRI to identify potential treatment strategies for brain injury in premature newborns that can then be tested in randomized trials."

To evaluate the effect of prolonged indomethacin treatment, the researchers used MRI to examine 57 premature newborns between 24 and 27 weeks' gestational age.

Moderate-severe white matter injuries were detected in 12 (21%) of 53 infants and 20 (35%) of 57 had moderate-severe brain abnormality. All had received indomethacin for short (1 to 3 doses) or prolonged (4 to 9 doses) periods in pharmacologically close a patent ductus arteriosus.

The researchers found that indomethacin exposure was the only factor significantly associated with reduced white matter injury. This relationship held after adjusting for a variety of factors including hemodynamically significant patent ductus arteriosus, gestational age at birth and systemic infection.

However, despite these interesting results, Dr. Miller stressed that "we do not suggest that our current findings guide future clinical practice. A randomized trial of prolonged indomethacin would be the necessary step before any change in clinical practice is suggested."