@article{Mitra:2024:10.1136/archdischild-2023-325445,
author = {Mitra, S and Whitehead, L and Smith, K and MacLean, B and Nixon, R and Veysey, A and Campbell-Yeo, M and Kuhle, S and Gale, C and Soll, R and Dorling, J and Johnston, BC},
doi = {10.1136/archdischild-2023-325445},
journal = {Archives of Disease in Childhood: Fetal and Neonatal Edition},
pages = {232--238},
title = {Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences},
url = {http://dx.doi.org/10.1136/archdischild-2023-325445},
volume = {109},
year = {2024}
}

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TY  - JOUR
AB  - Importance: Prophylactic cyclooxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks’ gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Objective: To develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants.Methods: The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence-to-Decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including five experienced neonatal care providers, two methods experts, one pharmacist, two parents of former extremely preterm infants and two adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis, and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. Recommendations: The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants [conditional recommendation, moderate certainty in estimate of effects]. Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group [conditional recommendation, low certainty in the estimate of effects]. The panel strongly recommended against use of prophylactic acetaminophen [strong recommendation, very low certainty in estimate of effects] until further research evidence is available.
AU  - Mitra,S
AU  - Whitehead,L
AU  - Smith,K
AU  - MacLean,B
AU  - Nixon,R
AU  - Veysey,A
AU  - Campbell-Yeo,M
AU  - Kuhle,S
AU  - Gale,C
AU  - Soll,R
AU  - Dorling,J
AU  - Johnston,BC
DO  - 10.1136/archdischild-2023-325445
EP  - 238
PY  - 2024///
SN  - 1359-2998
SP  - 232
TI  - Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences
T2  - Archives of Disease in Childhood: Fetal and Neonatal Edition
UR  - http://dx.doi.org/10.1136/archdischild-2023-325445
UR  - http://hdl.handle.net/10044/1/105225
VL  - 109
ER  - 

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