Spontaneous Intestinal Perforation Research Articles

EBNEO commentary: Long-term outcome of necrotizing enterocolitis and spontaneous intestinal perforation.

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Nasal High-Frequency Oscillatory Ventilation versus Nasal Intermittent Positive Pressure Ventilation In Pre-terms With Respiratory Distress Syndrome During Early Neonatal Period: A Randomized Controlled Trial

Objective: To determine the effectiveness of NHFOV versus NIPPV in reducing the need for invasive mechanical ventilation in preterm neonates with RDS (moderate-severe) during the first seven days of the life of neonate.
 Study Design: Randomized controlled study (ACTRN: 12622000291785).
 Place and Duration of Study: Neonatal Unit, PNS Shifa Hospital, Karachi Pakistan, from Jan to Aug 2021.
 Methodology: Forty-eight preterm neonates, with the gestational age of 27 weeks to 34 weeks with Respiratory distress Syndrome, were randomized to NHFOV Group (n=24) and NIPPV Group (n=24). The primary outcome was the need for invasive mechanical ventilation (IMV). The secondary outcomes were the duration of hospitalization, non-invasive respiratory support, mortality, abdominal distention, pneumothorax, need for surgery for patent ductus arteriosus, spontaneous intestinal perforation, and necrotizing enterocolitis, intraventricular haemorrhage≥ Grade-3, bronchopulmonary dysplasia, retinopathy of prematurity Stage-3.
 Results: There was no significant difference between NHFOV (64.7%) versus NIPPV (35.3%) groups in need of Invasive Mechanical Ventilation (p=0.13). Secondary outcomes were not significant between the two groups, air leak (p=0.31),necrotising enterocolitis (p=1.00), broncho-pulmonary dysplasia (p=0.31), retinopathy of prematurity (p=0.15).There was no intraventricular haemorrhage found between the two groups.
 Conclusion: Nasal high-frequency oscillatory ventilation was less statistically significant than NIPPV in reducing the need for invasive mechanical ventilation in the initial seven days of life in neonates with Respiratory distress syndrome.

Single cell analysis via mass cytometry of spontaneous intestinal perforation reveals alterations in small intestinal innate and adaptive mucosal immunity.

Spontaneous intestinal perforation (SIP) is a poorly understood severe gastrointestinal complications of prematurity which is poorly understood. Extremely premature infants born prior to 28 weeks' gestation develop a localized perforation of the terminal ileum during the first week of life and therapy involves surgery and cessation of enteral feeds. Little is known regardj g the impact of mucosal immune dysfunction on disease pathogenesis. We performed mass cytometry time of flight (CyTOF) of small intestinal mucosa of patients with SIP (Gestational age (GA) 24 - 27 weeks, n=8) compared to patients who had surgery for non-SIP conditions (neonatal (GA >36 weeks, n=5 ) and fetal intestine from elective terminations (GA 18-21 weeks, n=4). CyTOF analysis after stimulation of T cells with PMA/Ionomycin was also performed. We noted changes in innate and adaptive mucosal immunity in SIP. SIP mucosa had an expansion of ckit+ neutrophils, an influx of naïve CD4 and CD8 T cells and a reduction of effector memory T cells. SIP T cells were characterized by reduced CCR6 and CXCR3 expression and increased interferon gamma expression after stimulation. These findings suggest that previously unrecognized immune dysregulation is associated with SIP and should be explored in future studies.

Nucleated red blood cells as a potential biomarker for predicting spontaneous intestinal perforation in premature infants

Background: The specific etiology of spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) remains elusive. Both can present acutely without antecedent signs and can be difficult to differentiate. Neonatal nucleated red blood cell (NRBC) counts are part of the routine admission and serial CBCs drawn on premature neonates. Elevated NRBC counts could represent relative intrauterine hypoxemia, a possible risk factor for the development of SIP or NEC. Methods: We compared premature neonates with SIP to premature neonates with NEC and controls, matched gestational age (GA) and birth weight (BW). Kruskal-Wallis, Chi-Square, or Fisher's exact tests and univariate and multivariate nominal logistic regression models were used to estimate the association of baseline NRBC. Median times to SIP and NEC were calculated using the Kaplan-Meier method. All analyses were performed with SAS 9.4. Results: Male sex (72.5%), lower GA [Median (Q1, Q3): 25.1 (23.8, 28)], and lower BW [Median (Q1, Q3): 690 g (585, 1072)] had the highest incidence of SIP compared to NEC or controls. Increased baseline NRBC was associated with lower odds of developing NEC compared to controls [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 0.70 (0.55, 0.89), p-value = 0.0033]. Increased baseline NRBC was associated with higher odds of developing SIP compared to NEC [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 1.61 (1.18, 2.20) p-value = 0.0027]. There were no significant differences between intrauterine growth restriction (IUGR), maternal hypertension, chorioamnionitis, multiple births, or depressed APGAR scores in all three groups. NRBC for SIP neonates remained significantly higher at the day of life (DOL) 1-3 compared to other groups [Median (Q1, Q3): 23 (6, 93), p-value = 0.0020]. The percentage of patients with NRBC >4, remained elevated for patients with SIP as late as week three (p = 0.0023). Conclusion: ELBW, male sex, and elevated baseline NRBC were significantly associated with the risk of developing SIP compared to NEC or controls. NRBC remained significantly elevated on DOL 1-3, compared to NEC or controls. Between the groups, there were no significant differences in perinatal stressors.

438 - Enteral feeding after the surgical management of necrotizing enterocolitis and spontaneous intestinal perforation

438 - Enteral feeding after the surgical management of necrotizing enterocolitis and spontaneous intestinal perforation

Appendiceal perforation: A rare case of massive neonatal pneumoperitoneum

A pre-term newborn male was admitted to the pediatric cardiac intensive care unit with severe left ventricular and aortic hypoplasia. On day-of-life-13, massive pneumoperitoneum was incidentally identified on a chest radiograph after central line placement. Emergent exploration with thorough examination revealed only a focal perforation at the appendiceal tip. Standard appendectomy was performed; pathology showed appendiceal perforation with focal mucosal ulceration without inflammation . Literature review demonstrated neonates with appendiceal perforation have nonspecific symptoms at presentation (emesis, poor feeding, abdominal erythema) which may be difficult to distinguish from other etiologies of perforation. Infants with concomitant cardiac pathology are at increased risk for spontaneous intestinal perforation due to malperfusion. However, appendiceal perforation does not lead the differential for neonatal massive pneumoperitoneum; rather, large volume pneumoperitoneum typically results from gastric perforation. The true incidence is unknown with fewer than 10 reported cases; importantly, the literature often lacks distinction between spontaneous-perforation versus appendicitis-with-perforation. Given its rarity, discrete examination of the appendix and appendiceal pathology may be overlooked when evaluating neonates with pneumoperitoneum during a standard of care operative exploration. Particularly in patients with high-risk comorbidities where gastric or ileal pathology is not appreciated after thorough exploration, appendiceal perforation should be considered.

Clinical significance of black-bluish discoloration of the abdominal wall in the newborn

Abstract Background The aim of this study was to evaluate the clinical significance of the newborn with black-bluish discoloration of the abdominal wall (blue abdomen). Methods Between December 2007 and November 2016, neonates with blue abdomen referred for the suspicion of spontaneous intestinal perforation (SIP) were retrospectively reviewed. Clinical features and their prognosis were analyzed. Results During the study period, there were 10 neonates with blue abdomen. Of them, five neonates were proven as having SIP and the others were free of perforation. Enteral feeding was significantly associated with SIP (P = 0.038); however, gestational age, birth weight, gender, the timing of presentation, white blood cell count, platelets count, and the use of indomethacin as well as surfactant therapy were not significantly different between the two groups (P = 0.338, 0.610, 0.490, 0.326, 0.084, 0.741, 0.292, and 0.197, respectively). There was no statistically significant difference in survival between the two groups (P = 0.490). Conclusions Black-bluish discoloration of the abdominal wall may be a classical physical finding of SIP, but not be specific to SIP. The factor of enteral feeding might help to establish an appropriate diagnosis before invasive procedures. Because of high mortality, exploratory laparotomy should be avoided if there is no pneumoperitoneum.

Association between Abnormal Antenatal Doppler Characteristics and Gastrointestinal Outcomes in Preterm Infants

Antenatal Doppler disturbances are associated with fetal hypoxia and may induce a brain-sparing vascular redistribution at the expense of splanchnic circulation, possibly predisposing to gut complications. We aimed to compare several gastrointestinal outcomes among very-low-birthweight (VLBW) preterm infants with different antenatal Doppler features. VLBW infants born between 2010-2022 were retrospectively included and stratified into the following clusters based on antenatal Doppler characteristics: normal Doppler (controls); absent or reversed end-diastolic flow in the umbilical artery (UA-AREDF) alone or also in the ductus venosus (UA+DV-AREDF); and abnormal Doppler with or without brain-sparing redistribution. The following outcomes were evaluated: time to reach full enteral feeds (FEF), feeding intolerance (FI), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP). Overall, 570 infants were included. Infants born following UA+DV-AREDF had significantly higher FI, NEC, and SIP rates and achieved FEF later compared to controls. Increased FI prevalence and a longer time to FEF compared to controls were also observed among UA-AREDF infants and in the presence of brain-sparing redistribution, which also increased NEC rates. Antenatal Doppler abnormalities exacerbate the gastrointestinal risks of preterm infants. Detailed knowledge of Doppler features can aid in identifying those at highest risk of intestinal complications who may benefit from tailored enteral feeding management.

Feasibility and Impact of a Pilot Neonatal Cuddler Program on Preterm Infants in the Neonatal Intensive Care Unit.

Preterm infants experience daily stress in the neonatal intensive care unit (NICU). Positive sensory experiences mitigate stress responses, but parental participation can be limited by external pressures. This study aimed to describe the impact of a neonatal cuddler program (NCP) on preterm infants' growth. A multidisciplinary program trained volunteers to interact with NICU infants when family was not at bedside. Infants were followed prospectively throughout admission. Intervention data included frequency, type, and duration of activity throughout the study period. Student t-test and chi-square test were used to analyze the impact of volunteer interaction on anthropometric measures at discharge. Forty-five infants interacted with a volunteer (intervention group, n = 45) compared with the control group (n = 56) following coronavirus disease 2019 restrictions. The median (range) time of interaction with a volunteer in the intervention group was 90.0 (5.0-705.0) minutes per infant. Infants in the two groups had similar gestational ages, birth weights, lengths, and occipitofrontal circumferences (OFC). Infants in the intervention group had higher rates of spontaneous intestinal perforation, bronchopulmonary dysplasia, and reached full enteral feeds later. However, rates of severe intraventricular hemorrhage, retinopathy of prematurity, and duration of mechanical ventilation were similar. Infants in the two groups did not differ in the NICU length of stay. At discharge, infants in the intervention group weighed more (p = 0.04) and had higher OFC's (p = 0.01) and OFC z-scores (p = 0.03). The change in z-scores from birth to discharge was significant for the weight (p = 0.02) but not length or OFC. In regression analyses, only group allocation was identified as a significant factor for OFC z-scores at discharge (β= 0.279, p = 0.011) and for change in weight z-scores from birth to discharge (β = 0.226, p = 0.041). Growth is positively impacted by an NCP despite limited interaction. Additional work is needed to demonstrate the impact on neurobehavioral and developmental outcomes. · Establishing and implementing a neonatal cuddler program in a large, level IV NICU is feasible.. · Neonatal cuddler programs can provide positive sensory experiences when parents are not at bedside.. · Even limited exposure to these positive sensory experiences can positively impact growth parameters for preterm infants..

Abstract 11984: A Novel Pathogenic Gata6 Variant Identified in a Family With Persistent Truncus Arteriosus, Childhood-Onset Diabetes Mellitus and Spontaneous Intestinal Perforation

GATA6 is a member of the GATA family of transcription factors, among which GATA4, 5 and 6 are known to play critical roles during heart development. Pathogenic variants in GATA6 have been primarily associated with congenital heart disease (CHD) and pancreatic agenesis in humans. Although the phenotypic spectrum associated with pathologic variation in GATA6 has expanded to include developmental delay along with congenital malformations affecting the biliary system and diaphragm, the full disease spectrum of GATA6 pathogenic variation and genotype-phenotype correlations are unclear. Here, we report a family where the father had persistent truncus arteriosus (PTA) and three children had CHD, 2 with PTA and 1 with an atrial septal defect. Notably, the father had childhood-onset diabetes mellitus and one child had spontaneous intestinal perforation (SIP). Using exome sequencing, we identified a novel, heterozygous missense variant in GATA6 (c.1403G>A; p.Cys468Tyr) in affected members. This variant is absent from the gnomAD and ExAC databases and causes a missense change predicted to be damaging by all in silico bioinformatic tools. Sanger sequencing confirmed the exome sequencing results and segregation of this variant. GATA6 p.Cys468Tyr variant affects the highly conserved zinc-finger domain of GATA6 and impedes its ability to bind DNA. Using wild-type and mutant GATA6 constructs driving atrial natriuretic peptide promoter reporter, in vitro luciferase assays showed that p.Cys468Tyr mutant protein exhibited significantly decreased luciferase transcriptional activity. Furthermore, immunofluorescence revealed that p.Cys468Tyr mutant demonstrated an impaired localization pattern in the nucleus and induced protein aggregation. Our findings expand the variant and phenotypic spectrum for GATA6. Our study highlights that GATA6 variants can cause not only cardiac and pancreatic malformations but also gastrointestinal abnormalities, including neonatal SIP. Further investigation is needed to define the mechanisms underlying the full phenotypic spectrum associated with pathogenic variation in GATA6 .

What is the association between common medications (indomethacin, ibuprofen and acetaminophen) and spontaneous intestinal perforations in premature infants? A systematic review protocol

Background: Spontaneous intestinal perforation (SIP) affects very low birth weight preterm neonates and accounts for 44% of gastrointestinal perforations. Commonly used medications such as indomethacin, ibuprofen and acetaminophen for PDA closure, increases the risk of intestinal perforation. Unfortunately, the majority of the data combine SIP with those affected by necrotizing enterocolitis (NEC) despite them being separate entities. This systematic review aims to explore the association between the use of common medications and SIP in the premature infant cohort independently from NEC. Methods: Our study will focus on preterm infants with exposure to either indomethacin, ibuprofen or acetaminophen where SIP is a reported outcome. A health science librarian will search Medline and Medline in Process via OVID, Embase Classic + Embase via OVID, the LILACS database, the ScIELO database and the Cochrane Library including EBM Reviews - Cochrane Central Register of Controlled Trials. Search dates for each database will be from their respective dates of inception to March 2022. All articles will undergo screening by two independent reviewers, and if selected, data extraction with risk of bias assessment by two independent reviewers. A third reviewer will settle any disagreements that may occur. Incidence of SIP will be measured as a proportion. Individual proportions will be pooled using a random effects logistic regression model. The comparative incidence of SIP by treatment group will be measured using the odds ratio. Odds ratios will be pooled using the DerSimonian and Laird random effects model for meta-analysis. PROSPERO Registration: CRD42017058603

Mortality and neurodevelopmental outcomes of infants with spontaneous intestinal perforation: a systematic review and meta-analysis

BackgroundThere is limited information about the mortality and neurodevelopmental outcomes of very preterm infants (<32 weeks) with spontaneous intestinal perforation (SIP).ObjectiveTo explore the association between SIP and neurodevelopmental outcomes and...

Use of paracetamol for the treatment of patent ductus arteriosus in premature Newborns: A systematic review

Objective: Patent ductus arteriosus is associated with multiple complications and high neonatal mortality. This study aimed to evaluate the efficacy and benefits of paracetamol compared to ibuprofen and indomethacin, non-steroidal anti-inflammatory drugs usually used to close the ductus arteriosus in premature newborns. Data source: We searched the PubMed, SciELO, Lilacs, Bireme, ClinicalTrials.gov and Embase databases for articles published between January 2005 and December 2020. The descriptors used were: premature newborn, patent ductus arteriosus, pharmacotherapy, closure and paracetamol / acetaminophen. The quality of the articles was evaluated by the classification of the Oxford Centre for Evidence based Medicine. Data synthesis: The efficacy of paracetamol is comparable to that of ibuprofen and indomethacin, and it is associated with lower rates of gastrointestinal and intracerebral hemorrhage, spontaneous intestinal perforation, thrombocytopenia, hepatic and renal intolerance, and lower serum values of urea, creatinine, and bilirubin. Furthermore, it is more advantageous than placebo or nonintervention and may be the best option in cases with contraindications for other drugs. Gestational age and birth weight were factors that influenced the efficacy of paracetamol and showed reduced efficacy in extremely premature newborns with extremely low and very low birth weights. Conclusions: Other clinical and prospective studies are needed to support the indication of paracetamol in patent ductus arteriosus. However, this drug proves to be a promising pharmacological alternative, having similar efficacy to classic non-steroidal anti-inflammatory drugs, with fewer adverse effects.

Development of necrotizing enterocolitis after blood transfusion in very premature neonates.

Prior studies report conflicting evidence on the association between packed red blood cell (PRBC) transfusions and necrotizing enterocolitis (NEC), especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC. The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life (DOL) 14 in verypremature neonates. A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14. Primary endpoints were PRBC transfusions after DOL 14 until the date of NEC diagnosis, discharge, or death. Wilcoxon ranked-sum and Fisher's exact tests, Cox proportional hazards regression, and Kaplan-Meier curves were used to analyze data. Of 549 premature neonates, 186 (34%) received transfusions after DOL 14 and nine (2%) developed NEC (median DOL = 38; interquartile range = 32-46). Of the nine with NEC after DOL 14, all were previously transfused (P < 0.001); therefore, hazard of NEC could not be estimated. Post hoc analysis of patients from DOL 10 onward included five additional patients who developed NEC between DOL 10 and DOL 14, and the hazard of NEC increased by a factor of nearly six after PRBC transfusion (hazard ratio = 5.76, 95% confidence interval = 1.02-32.7; P = 0.048). Transfusions were strongly associated with NEC after DOL 14. Prospective studies are needed to determine if restrictive transfusion practices can decrease incidence of NEC after DOL 14.

Long-Term Outcome of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation.

Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are complications in preterm infants associated with high morbidity, mortality, impaired growth, and neurodevelopmental (ND) outcomes. Few studies have reported growth or ND outcomes of infants born extremely preterm with NEC/SIP beyond early childhood. Here, we compared anthropometric and ND outcomes, at 10 and 15 years, for children with medical NEC, surgical NEC, SIP, and neither NEC nor SIP. Participants from the prospective longitudinal extremely low gestational age newborns study were evaluated at ages 10 and 15 years for anthropometrics, neurocognition, attention-deficit/hyperactivity disorder, epilepsy, and gross motor function. At age 10 years, 889 children were followed-up (medical NEC = 138, surgical NEC = 33, SIP = 29, no NEC/SIP = 689), and 694 children were followed up-at 15 years. Children with medical NEC had similar weight, BMI, height, and head circumference compared with controls at both 10 and 15 years. At 15 years, children with surgical NEC had lower weight z-score (adjusted β: -0.75, 95% confidence interval [CI]: -1.25 to -0.25), lower BMI z-score (adjusted β: -0.55, 95% CI: -1.09 to -0.01), and lower height z-score (adjusted β: -0.65, 95% CI: -1.16 to -0.14). Children with SIP had lower weight and height z-scores at age 10 years when adjusted for sample attrition, but these differences were not significant when adjusted for confounders. We observed no differences in long-term ND outcomes. Surgical NEC- and SIP-associated growth impairment may persist through late childhood. ND outcomes among school-aged children born extremely preterm with any NEC or SIP are no different from children without NEC/SIP.

Spontaneous Intestinal Perforation in a Full Term Neonate: A Case Report

Spontaneous intestinal perforation suggests a perforation of the gastrointestinal tract of no demonstrable cause. Only few such cases have been described in full term newborns. Although some authors have suggested ischemia and fetal or neonatal hypoxia as the most likely cause, the etiology and pathogenesis of this disease are still widely unknown. Here, we present a case of Spontaneous intestinal perforation in a full term neonate who was born to a mother with chronic hypertension. Radiological images revealed pneumoperitoneum on a three day old baby with feeding intolerance and abdominal distention. There was no clinical evidence of Hirschsprung’s disease, necrotizing enterocolitis, anorectal malformations or bowel obstruction. An emergency laparotomy revealed a localized perforation in distal ileum. Histopathological examination failed to reveal any etiology for the perforation. The neonate recovered rapidly following a double barrel ileostomy, with no immediate gastrointestinal complications.

The Metabolome and the Gut Microbiota for the Prediction of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation: A Systematic Review.

Necrotizing enterocolitis (NEC) is the most devastating gastrointestinal emergency in preterm neonates. Research on early predictive biomarkers is fundamental. This is a systematic review of studies applying untargeted metabolomics and gut microbiota analysis to evaluate the differences between neonates affected by NEC (Bell’s stage II or III), and/or by spontaneous intestinal perforation (SIP) versus healthy controls. Five studies applying metabolomics (43 cases, 95 preterm controls) and 20 applying gut microbiota analysis (254 cases, 651 preterm controls, 22 term controls) were selected. Metabolomic studies utilized NMR spectroscopy or mass spectrometry. An early urinary alanine/histidine ratio >4 showed good sensitivity and predictive value for NEC in one study. Samples collected in proximity to NEC diagnosis demonstrated variable pathways potentially related to NEC. In studies applying untargeted gut microbiota analysis, the sequencing of the V3–V4 or V3 to V5 regions of the 16S rRNA was the most used technique. At phylum level, NEC specimens were characterized by increased relative abundance of Proteobacteria compared to controls. At genus level, pre-NEC samples were characterized by a lack or decreased abundance of Bifidobacterium. Finally, at the species level Bacteroides dorei, Clostridium perfringens and perfringens-like strains dominated early NEC specimens, whereas Clostridium butyricum, neonatale and Propionibacterium acnei those at disease diagnosis. Six studies found a lower Shannon diversity index in cases than controls. A clear separation of cases from controls emerged based on UniFrac metrics in five out of seven studies. Importantly, no studies compared NEC versus SIP. Untargeted metabolomics and gut microbiota analysis are interrelated strategies to investigate NEC pathophysiology and identify potential biomarkers. Expression of quantitative measurements, data sharing via biorepositories and validation studies are fundamental to guarantee consistent comparison of results.

Spontaneous intestinal perforation in critical COVID: A case report

Spontaneous intestinal perforation is a rare extrapulmonary manifestations of critical COVID-19 case. The pathogenesis of viral etiology is still unclear and association to some essential therapeutic treatment such as steroid or interleukin-9 antagonist is also inconclusive. Surgery is not mandatory If source control and sepsis can be accomplished with available interventions reported in current literatures. This uncommon complication develops either at time of presentation or after hospital admission, both upper and lower gastrointestinal tract1 We reported an ARDS patient experienced cardiac thrombus without valvular defect or arrhythmia who was diagnosed of spontaneous intestinal perforation from acute necrotizing ileitis necessitated damage control surgery.

Development of artificial neural networks for early prediction of intestinal perforation in preterm infants

Intestinal perforation (IP) in preterm infants is a life-threatening condition that may result in serious complications and increased mortality. Early Prediction of IP in infants is important, but challenging due to its multifactorial and complex nature of the disease. Thus, there are no reliable tools to predict IP in infants. In this study, we developed new machine learning (ML) models for predicting IP in very low birth weight (VLBW) infants and compared their performance to that of classic ML methods. We developed artificial neural networks (ANNs) using VLBW infant data from a nationwide cohort and prospective web-based registry. The new ANN models, which outperformed all other classic ML methods, showed an area under the receiver operating characteristic curve (AUROC) of 0.8832 for predicting IP associated with necrotizing enterocolitis (NEC-IP) and 0.8797 for spontaneous IP (SIP). We tested these algorithms using patient data from our institution, which were not included in the training dataset, and obtained an AUROC of 1.0000 for NEC-IP and 0.9364 for SIP. NEC-IP and SIP in VLBW infants can be predicted at an excellent performance level with these newly developed ML models. https://github.com/kdhRick2222/Early-Prediction-of-Intestinal-Perforation-in-Preterm-Infants.

Tolerance of hydrocortisone prophylaxis administration in extreme preterm neonates: Experience of a single UK level III neonatal unit

ObjectiveTo assess the safety of the routine use of low-dose prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia (BPD) in infants born <28 weeks' gestation. DesignA single-centre retrospective cohort study of infants born <28 weeks, before and after hydrocortisone implementation. Data was collected from electronic patient records and compared between both groups. Main outcome measuresThe incidence of serious adverse events associated with hydrocortisone use was measured in each group. The rates of spontaneous intestinal perforation (SIP), late onset sepsis (LOS). Necrotising enterocolitis (NEC) and BPD were compared. ResultsThere were 88 infants in the pre-hydrocortisone group and 103 infants in the hydrocortisone group. In comparison to the pre-hydrocortisone group, the incidence of SIP in the hydrocortisone group was 7.7 % (vs 3.4 % p = 0.2), NEC 30 % (vs 25 % p = 0.43) and LOS 34 % (vs 30.6 % p = 0.63) Rates of BPD in the hydrocortisone group were 59 % (vs 52.2 % p = 0.33) mortality 18.4 % (vs 20.4 % p = 0.73) and BPD free survival 26.2 % (vs 27.2 % p = 0.87).Infants who received hydrocortisone had a significantly lower requirement of inotropic support of 32 % vs 48.3 % (p = 0.02). Results remained unchanged after logistic regression analyses for potential confounding factors (ethnicity, chorioamnionitis, multiple pregnancy and antenatal steroids). ConclusionProphylactic administration of low-dose hydrocortisone for BPD to infants born below 28 weeks' gestation was not associated with an increase in serious adverse outcomes in our population.