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Indomethacin to Treat Pre-Term Labor Linked to Cerebral Palsy, Intestinal Problems in Premature Infants

Nov 2, 2007 | Parker Waichman Alonso LLP

Indomethacin, a drug used to stop pre-term labor, has been linked to an increased incidence of birth injuries such as brain damage, including cerebral palsy, and intestinal problems in premature infants, according to new research published in the American Journal of Obstetrics and Gynecology.   The study's findings could provide new guidance to doctors on when and how to administer indomethacin to treat pre-term labor in order to avoid these drug side-effects.

When a woman goes into a pre-term labor, it is likely that her baby will be born without the ability to breath on its own.  Obviously, a physician would want to do everything possible to keep this from happening.  One common method of dealing with pre-term labor is to give the mother a combination of a tocolytic agent and a steroid.   The tocolytic agent, in this case indomethacin, slows down or stops labor, while the steroid speeds up the development of the unborn baby’s lungs.  After the steroids have been given a couple of days to work, the mother is taken off indomethacin and her baby is allowed to be born.

It has been known for some time that indomethacin affected blood flow to the fetus, but the ramifications of this drug side-effect have never been fully studied.  This new study, conducted by researchers at the University of Rochester Medical Center, is the first to take an in-depth look at the health consequences of indomethacin use in premature babies.  The study involved an analysis of a group of indomethacin studies called a metaanalysis.  

From the metaanalysis, the University of Rochester scientists were able to conclude that indomethacin treatment can have some very serious consequences for babies.  The study showed an association between indomethacin and necrotizing entercolitis, a condition in which intestinal tissue dies.  While this condition can be treated with antibiotics, it often requires surgery and can be fatal. Indomethacin was also associated with periventricular leukomalacia, a disorder that reduces blood flow to the white matter of the brain and often leads to cerebral palsy.  The researchers did not find any association between indomethacine and bleeding in the brain, congenital heart defects and respiratory distress syndrome.

Most obstetricians only use indomethacin when a baby is going to be born extremely early.  Although some doctors use it when a pregnancy is further along, believing that indomethacin has fewer side effects than other tocolytic agents.  The authors of the new indomethacin study told Science Daily that they hope their findings will discourage doctors from using indomethacin when it is not necessary.  Indomethacin should only be used when it is certain that a premature baby will be unable to breathe on its own, and not simply to give it more time in its mother’s womb.