PRophylactic Indomethacin in MicropreemiEs (PRIME) – a retrospective cohort study

Infants born extremely prematurely, especially before 26 weeks’ gestational age (GA), are classified as micropreemies and are considered the most vulnerable population. These babies often face serious short and long-term health challenges. One common problem is intraventricular hemorrhage (IVH), a type of brain bleed that remains the leading cause of death in this vulnerable population. Severe IVH (sIVH) can lead to significant lasting effects such as cerebral palsy, reduced IQ, and overall neurodevelopmental disabilities. Clinical trials have shown that preventative indomethacin, a nonsteroidal anti-inflammatory drug, can prevent sIVH and death. In Canada, babies born before 26 weeks’ GA from 2018-2022 who received indomethacin had a 5% lower death rate and were 4% more likely to survive without sIVH in comparison to those who did not receive the drug. Although past studies have shown that prophylactic indomethacin can reduce both sIVH and death, its use in clinical practice remains inconsistent due to concerns about potential negative effects. The proposed study, PRophylactic Indomethacin in MicropreemiEs (PRIME), specifically examines the impact of prophylactic indomethacin on short- and long-term neurodevelopmental outcomes in the micropreemie cohort. The pan-Canadian retrospective observational study will link data from the Canadian Neonatal Network and Canadian Neonatal Follow Up Network to investigate the relationship between preventative indomethacin and death and disability in extremely premature infants. Additionally, neurodevelopmental outcomes will be explored at 18-24 months. Una Spasovski, a master’s student in the Women+ and Children’s Health program at the University of British Columbia, will lead this study in British Columbia. Under the supervision of Dr. Souvik Mitra, her research specifically focuses on improving outcomes for extremely premature infants at the BC Children’s Hospital Research Institute.