Intraventricular Hemorrhage in the Preterm Infant Medication

Updated: Jul 24, 2018
  • Author: David J Annibale, MD; Chief Editor: Santina A Zanelli, MD  more...
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Medication Summary

Pharmacologic intervention in the prevention and treatment of germinal matrix/intraventricular hemorrhage (GM/IVH) and posthemorrhagic hydrocephalus remains controversial.


Prostaglandin inhibitors

Class Summary

Prostaglandin inhibitors are postulated to perform prostaglandin synthesis inhibition. They inhibit free radical formation and accelerate maturation of germinal matrix vasculature. Indomethacin has been shown to decrease the risk of high-grade PVH-IVH. However, developmental outcomes have not been shown to be improved with the use of indomethacin prophylaxis. For this reason, the role of indomethacin in the prevention of IVH remains uncertain. Analysis of patients enrolled in a multicenter trial of indomethacin prophylaxis suggests that prophylaxis is effective in male infants but not in female infants. This remains to be confirmed through prospective evaluations.

Other members of this class of drugs have not been demonstrated to be of value in reducing the incidence of PVH-IVH.

Indomethacin (Indocin)

Indomethacin use is controversial but possibly indicated in patients at risk for GM/IVH, including those younger than 32 weeks' gestation or those who weigh less than 1250 g at birth. Among its actions, indomethacin inhibits the formation of prostaglandins by decreasing the activity of cyclooxygenase. Additionally, through poorly understood mechanisms, indomethacin causes maturation of the germinal matrix microvasculature. It is also associated with decreased cerebral blood flow, cerebral blood flow velocity, and cerebral blood volume, especially when administered rapidly. Alterations of oxidative metabolism are also suggested. Unfortunately, there are conflicting data regarding long-term improvement in outcomes.