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113 NEONATOLOGY WITHOUT INDOMETHACIN OR BOWEL PERFORATION: A 19-YEAR EXPERIENCE.
  1. J. Pietz,
  2. P. Achanti,
  3. E. C. Stepka,
  4. S. Mehta
  1. Fairview Hospital, Cleveland, OH

Abstract

Objective Review the use of indomethacin and a strict feeding protocol for VLBW.

Methods Review the incidence of NEC, IVH, and bowel perforation as our policies for using Indocin and a strict feeding protocol changed. From 1986-1991, 0/228 VLBW babies had NEC. 0/228 had bowel perforation. From 1991-2001, 0/683 VLBW babies had bowel perforation. Before 2001, our feeding protocol advanced only 4 mL/kg/day for VLBW babies. In 2001, the protocol was liberalized and Indocin use was allowed. In April of 2003, after 2 cases of NEC, we reverted to the original feeding protocol and stopped using Indocin. For 2001-2004 we compare 261 VLBW babies to the Vermont-Oxford network. 10/149 infants received indomethacin in 2001-2002. 0/112 infants received indomethacin in 2003-2004. Two infants had NEC (2/261). The first received Indocin and was on liberal feedings. The second had no Indocin but was on liberal feedings. Both recovered without surgery. Rates of NEC, bowel perforation, IVH, and CLD are shown below. Comparisons to 2003 Vermont-Oxford data are shown below. Our incidence of IVH, SIVH, NEC, bowel perforation, and BPD was lower than network. Studies show prophylactic Indocin is associated with reduced incidence of IVH. In Bandstra's study the early Indocin group had incidence of IVH greater than ours (23% vs 11%). In Ment's study an early Indocin group had an incidence (12% vs 11%) similar to ours. In the last 30 months, we have not used Indocin and we adhere to our feeding protocol. Our NEC rate is again 0%; our bowel perforation rate from 1986-2004 = 0/1172. Our IVH and BPD rates are also low.

Conclusion In this NICU using our feeding protocol without Indocin is advisable.

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