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Sanjay Chawla1,2, Girija Natarajan1,2, Abbot R. Laptook3, Dhuly Chowdhury4, Edward F. Bell5, Namasivayam Ambalavanan6, Waldemar A. Carlo6, Marie Gantz4, Abhik Das7, Jose L. Tapia8, Heidi M. Harmon5, Seetha Shankaran1. Model for severe intracranial hemorrhage and role of early indomethacin in extreme preterm infants. Mar 17 2022. Nature

BACKGROUND: To develop a model for prediction of severe intracranial hemorrhage (ICH) or death based on variables from the first 12 h of age and to compare mortality and morbidities with and without exposure to early indomethacin. METHODS: This retrospective cohort study included extreme preterm (220/7−266/7 weeks) infants born at National Institute of Child Health and Human Development Neonatal Research Network sites. Primary outcome was a composite of severe ICH and/or death. RESULTS: Of 4624 infants, 1827 received early indomethacin. Lower gestation, lack of antenatal steroids exposure, lower 1-min Apgar, male sex, and receipt of epinephrine were associated with severe ICH or death. Early indomethacin was associated with a lower risk of patent ductus arteriosus, bronchopulmonary dysplasia, and higher risk of spontaneous intestinal perforation. CONCLUSIONS: A model for early prediction of severe ICH/death was developed and validated. Early indomethacin was associated with a lower risk of patent ductus arteriosus and bronchopulmonary dysplasia and a higher risk of spontaneous intestinal perforation.

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