Background Prophylactic trials with indomethacin have consistently revealed short term benefits like a decreased need for PDA ligation (RR 0.51), decreased incidence of pulmonary haemorrhage (RR 0.35), and serious IVH (RR 0.66).

The use of indomethacin prophylaxis increased after Ment trial while decreased after TIPP trial as no long term improvement in neurodevelopmental outcome was reported. However, TIPP trial was under-powered to study long term neurodevelopmental outcome.

Aims and objectives To find out the current practice on use of prophylactic indomethacin in extremely pre-term infants.

Design and methods Questionnaire based international survey from 51 tertiary neonatal units across 9 countries (including United Kingdom, USA, New Zealand and Australia). The neonatologists were contacted via email or telephone to find out current practice on use of prophylactic indomethacin in extremely pre-term infants.

Results 5 of 51 (10%) tertiary neonatal units use prophylactic indomethacin in extremely pre-term infants. In the UK 3 of the 44 units (6.8%) use prophylactic indomethacin. 2 units in the USA use prophylactic indomethacin.

Practice varies across the units – 2 units use prophylactic indomethacin for all infants < 28 weeks of gestation while other units use on targeted infants.

Conclusion Use of prophylactic indomethacin declined after TIPP trial but it’s use has further declined because of unavailability (short of supply from manufacturer). In the UK use of prophylactic indomethacin has declined from 5 to 3 centres recently. Our survey also showed that some neonatal units would like to use prophylactic indomethacin but indomethacin is not available currently.