Neonates tocolytics

Antenatal indometacin therapy has been extensively reviewed (SEDA-18, 102). Data from a retrospective cohort study of 57 premature infants, bom between the 24th and 30th weeks of gestation, whose mothers had been treated unsuccessfully with indometacin for preterm labor, confirmed several fetal and neonatal complications (52). However, the overall results provided inconclusive or contradictory data on the benefit to harm balance of indometacin as a tocolytic agent or as treatment for hydramnios (SEDA-18,102). 

The possible association of indometacin tocolysis with neonatal necrotizing enterocolitis has been the subject of a case-control study (53). All cases of proven necrotizing enterocolitis were ascertained and four controls for each case were randomly identified. During 18 months there were 24 cases of necrotizing enterocolitis. Indometacin as a single tocolytic agent was not associated with necrotizing enterocolitis (OR = 1.0, 95% Cl = 0.2, 4.8). 

A report has confirmed the potential danger of using nimesulide as a tocolytic agent (SEDA 24, 123). Nimesulide (100 mg bd) was prescribed for postoperative preterm labor prophylaxis, and severe oligohydramnios was identified 3 weeks later (20). After withdrawal the amniotic fluid volume returned to normal over 2 weeks. There were no adverse neonatal renal effects. 

Pernzzi L, Gianoglio B, Porcellini MG, Coppo R. Neonatal end-stage renal faUnre associated with maternal ingestion of cyclo-oxygenase-type-1 [Sic] selective inhibitor nimesulide as tocolytic. Lancet 1999 354(9190) 1615. 

Because infection has been thought to play a role in the etiology of preterm labor, antibiotics have been used, in addition to tocolytics and corticosteroids, to improve the outcome of preterm labor. Most studies of antibiotic use in preterm labor do not demonstrate a reduction in the incidence of preterm delivery, and a meta-analysis shows a trend toward neonatal mortality in those who receive antibiotics. Routine use of antibiotics therefore is not recommended. 

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