The thoughtful comments of Drs Hallman, Personen, and Teramo regarding our recently published metaanalysis are appreciated. We are aware of the ongoing interest of these researchers on the adverse effects of antenatal exposure to indomethacin, including an elevated risk for bronchopulmonary dysplasia (BPD).
While attempting to replicate their subgroup analysis of our data, excluding comparison groups not receiving tocolytics, we noted an abstraction error that resulted in an incorrect pooled effect estimate for the BPD outcome. In our report, the data as reported by Van Overmeire et al were transposed inadvertently, resulting in an incorrect pooled relative risk of BPD of 1.12 (95% confidence interval, 0.79–1.59).
We have revised our metaanalysis overall and, in particular, for the BPD outcome, and we conclude that the use of indomethacin as a tocolytic agent is associated not only with an increased risk for severe intraventricular hemorrhage, necrotizing enterocolitis, and periventricular leukomalacia but also for BPD (relative risk, 1.37; 95% confidence interval, 1.19–1.60; Table ).
| Study | Group (n/N) | Relative risk (95% confidence interval) | |
|---|---|---|---|
| Exposed | Not exposed | ||
| Van Overmeire | 18/38 | 9/38 | 2.00 (1.03-3.88) |
| Ojala | 3/82 | 2/94 | 1.72 (0.29-10.04) |
| Gerson | 3/24 | 4/33 | 1.03 (0.25-4.19) |
| Al-Alaiyan | 2/15 | 4/15 | 0.50 (0.11-2.33) |
| Soraisham | 61/75 | 75/148 | 1.35 (1.16–1.57) |
| Sood | 22/63 | 106/565 | 1.86 (1.27–2.72) |
| Vermillion | 19/75 | 39/150 | 0.97 (0.61–1.56) |
| M-H pooled RR | 1.37 (1.19–1.59) | ||
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