Related Experiment Video
Updated: Aug 14, 2026
An Intravital Microscopy-Based Approach to Assess Intestinal Permeability and Epithelial Cell Shedding Performance
Published on: December 3, 2020
New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early
J T Attridge1, R Clark, M W Walker
1University of Virginia Children's Hospital, Charlottesville, VA 22908, USA.
Insights
Early indomethacin use in premature infants is linked to spontaneous intestinal perforation (SIP), even when not combined with glucocorticoids. This finding highlights potential risks of prophylactic indomethacin in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Pharmacology
Background:
- Spontaneous intestinal perforation (SIP) is a growing concern in premature infants, associated with considerable morbidity.
- Previous research suggested indomethacin, when used with glucocorticoids, might increase SIP risk, but not as an independent factor for prophylactic use.
Purpose of the Study:
- To create a distinct cohort of SIP patients from national data and compare them with surgical necrotizing enterocolitis (NEC) cases.
- To investigate if early postnatal indomethacin administration independently correlates with SIP.
Main Methods:
- Retrospective analysis of a large de-identified dataset, querying by diagnosis.
- Univariate and multivariate analyses of antenatal and postnatal variables, including drug administration timing, to identify SIP associations.
Main Results:
- The study included 2105 patients: 581 controls, 633 SIP (no NEC), and 891 surgical NEC.
- SIP patients exhibited higher rates of patent ductus arteriosus and vasopressor use compared to controls and NEC patients.
- SIP infants were smaller, less mature, diagnosed earlier (median 7 vs. 15 days), and more likely to receive early postnatal indomethacin (days 0-3) than controls.
Conclusions:
- Surgical NEC and SIP present with distinct demographic, clinical, and morbidity profiles.
- Early postnatal indomethacin administration is independently associated with spontaneous intestinal perforation in premature infants.
Background:
Spontaneous intestinal perforation (SIP) is increasingly common in the premature infant and is associated with significant morbidity. Indomethacin use has been implicated as a co-risk factor for SIP when combined with glucocorticoids, but previous evidence argued against indomethacin being an independent risk factor when used prophylactically.
Objectives:
(1) To establish a homogeneous cohort of SIP patients in a national data set and to contrast them to patients with surgical necrotizing enterocolitis (NEC). (2) To test the hypothesis that early post-natal indomethacin is independently associated with SIP.
Methods:
A large de-identified data set was retrospectively queried by diagnosis, and then multiple antenatal and post-natal variables were tested by both univariate and multivariate analysis to identify associations with SIP. Sub-analyses were also performed to look at the timing of drug administration.
Results:
There were 2105 patients evaluated in the data set. Patients were divided into matched controls (n = 581), those with SIP without report of NEC (n = 633) and those with NEC requiring surgery (n = 891). Infants with SIP were more likely to have a patent ductus arteriosus and more likely to be treated with vasopressors than either control or NEC patients. Compared to infants with NEC, patients with SIP were smaller, less mature and required more support. SIP was also diagnosed earlier than NEC (median of 7 vs 15 days). Patients with SIP were more likely to be treated with indomethacin, hydrocortisone or both on days of life 0-3 than controls.
Conclusions:
(1) Surgical NEC and SIP have significant differences in presentation, demographics and morbidity. (2) A detailed look at drug timing revealed that early post-natal indomethacin is independently associated with SIP.
Related Concept Videos
01:22Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus.
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:24Peptic Ulcer Disease II: Pathophysiology
01:07Intestinal Obstruction II: Pathophysiology
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...