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Objective:Intraventricular hemorrhage (IVH) occurs in up to 25% of very low birth weight (VLBW) preterm neonates. Previous studies found that indomethacin administered in the first 6 h of life reduces the incidence of severe IVH in VLBW neonates and decreases cerebral blood flow, suggesting a decrease in cerebral oxygen delivery. Using near-infrared spectroscopy (NIRS), we monitored cerebral oxygenation before, during and after slow indomethacin infusion in extremely low birth weight (ELBW) neonates to determine whether indomethacin decreases cerebral oxygen saturation and increases cerebral oxygen extraction.Study Design:Twenty-seven ELBW neonates less than 30 weeks gestational age treated with indomethacin for IVH prophylaxis were monitored for arterial oxygen saturation (SaO2) and NIRS-determined regional cerebral oxygen saturation (rSO2). At 30 to 60 s intervals, SaO2, rSO2 and mean arterial pressure (MAP) were recorded using a VitalSync. Average fractional cerebral oxygen extraction was calculated for the hour before indomethacin infusion, during the infusion and 2 h after infusion.Result:Fractional cerebral oxygen extraction increased from baseline after indomethacin administration from 0.23±0.11 to 0.25±0.10 (P=0.034).Conclusion:Fractional cerebral oxygen extraction increased 9% with indomethacin 0.1 mg kg−1 given over 1 to 2 h. However, the clinical implications of this small increase in extraction, likely representative of decreased cerebral perfusion, are unknown but may be harmful to the developing brain. [ABSTRACT FROM AUTHOR]

We describe 10 apparently healthy newborns who were patients in a level 1 nursery and were found by caregivers to be limp, apneic, and requiring resuscitation. All patients were between ages 15 hours and 3 1/2 days, products of term gestations, and of appropriate weight for gestational age. Prenatal or perinatal complications were present in nine of the 10 patients; in no patient was the complication considered a risk for serious, late-onset neonatal problems. All patients had been examined by a physician and were deemed to be in good health before the apparent life-threatening event. Subsequent to the event, each patient required positive pressure ventilation and seven patients received chest compressions. Five patients died. Autopsies were performed on four of the five patients and in none was an adequate explanation for death established. Intrathoracic petechiae were found in one patient whose sibling had died of sudden infant death syndrome at age 11 weeks. Evaluation of the five survivors failed to determine a cause for the episodes. Of the five survivors, one had normal results of developmental examination at age 6 months, while the remaining four survivors had severe neurologic impairment at age 1 year. Apparent life-threatening events occur in hospitalized newborns presumed to be normal and may be a manifestation of early sudden infant death syndrome or early near-miss sudden infant death syndrome.