This study states that Two reports in the current volume of The Journal use large data sets from the Canadian Neonatal Network to ask questions about postnatal indomethacin exposures and spontaneous intestinal perforation (SIP) and gestational age variations in neonatal outcomes from postnatal indomethacin such as early death.1,2 Qureshi et al specifically questioned whether antenatal steroid use influenced the incidence of SIP with postnatal indomethacin use, as suggested by Shah et al.1 Both studies suffer from the same weakness—the infrequent and idiosyncratic use of postnatal indomethacin across the network sites—variable use within sites varied from 0% to 78% for extremely low birth weight infants in gestational age ranges are less than 236/7 weeks and treatment with postnatal indomethacin within 12 hours of birth. Because only 11% of the cohort studied by Shah et al received postnatal indomethacin, the exposed infants are a highly selected subpopulation, as reported in the Qureshi et al report. The striking effect of postnatal indomethacin vs gestational age for early death and complications of prematurity is most striking.

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