Intestinal perforation in very preterm neonates: risk factors and outcomes

J Perinatol. 2015 Aug;35(8):595-600. doi: 10.1038/jp.2015.41. Epub 2015 Apr 30.

Abstract

Objective: To compare neonatal outcomes of preterm infants (born at <32 weeks' gestation) with focal/spontaneous intestinal perforation (SIP), necrotizing enterocolitis (NEC)-related perforation, NEC without perforation or no NEC/perforation.

Study design: Retrospective cohort study of 17,426 infants admitted to Canadian neonatal intensive care units during 2010 to 2013. The primary outcome was a composite of mortality or morbidity (bronchopulmonary dysplasia, severe retinopathy, periventricular leukomalacia or nosocomial infection). Association of intestinal perforation with neonatal outcome was evaluated using multivariate logistic regression.

Result: SIP was present in 178 (1.0%) infants, NEC-related perforation in 246 (1.4%) and NEC without perforation in 538 (3.1%). Any intestinal perforation was associated with higher odds of the composite outcome (adjusted odds ratio (AOR): 8.21, 95% confidence interval (95% CI) 6.26 to 10.8); however, the odds were significantly lower for focal/SIP compared with NEC-related perforation (AOR: 0.29, 95% CI 0.17 to 0.51).

Conclusion: Of the two types of intestinal perforation, NEC-related perforation was associated with the highest risk of an adverse neonatal outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Cross Infection / epidemiology*
  • Enterocolitis, Necrotizing / complications
  • Enterocolitis, Necrotizing / diagnosis*
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Infant, Premature, Diseases / classification*
  • Infant, Premature, Diseases / epidemiology*
  • Intensive Care Units, Neonatal
  • Intestinal Perforation / diagnosis*
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index