Retrospective study of clinical outcomes with hydrocortisone versus indomethacin prophylaxis in preterm neonates

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Abstract Objective Indomethacin and hydrocortisone prophylaxis may improve clinical outcomes when administered to extremely preterm neonates. However, they cannot be administered together and there is limited evidence to support which therapy may be most beneficial. Study Design: A retrospective matched cohort study was conducted in neonates less than 28 weeks gestational age (GA) and birth weight less than 1000 grams who received prophylaxis with indomethacin or hydrocortisone. Multivariable logistic regression analysis was used to evaluate clinical outcomes. Results Among 177 neonates, 40 treated with prophylactic hydrocortisone were matched with 137 neonates treated with prophylactic indomethacin. Indomethacin-treated neonates had significantly lower incidence of PDA, PDA requiring surgical closure, late-onset sepsis, and higher rates of survival without oxygen supplementation at discharge. There was no difference in mortality, BPD, NEC, or IVH. Conclusion When compared to hydrocortisone, indomethacin prophylaxis was associated with more favorable outcomes.