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An Intravital Microscopy-Based Approach to Assess Intestinal Permeability and Epithelial Cell Shedding Performance
07:32

An Intravital Microscopy-Based Approach to Assess Intestinal Permeability and Epithelial Cell Shedding Performance

Published on: December 3, 2020

Understanding clinical literature relevant to spontaneous intestinal perforations

Phillip V Gordon1, Joshua T Attridge

  • 1Ochsner Health System, New Orleans, Louisiana 70121, USA. pvgordon@oshcner.org

American Journal of Perinatology
|December 11, 2008
PubMed

Insights

Spontaneous intestinal perforation (SIP) in extremely low-birth-weight infants is linked to early postnatal steroids and indomethacin. Understanding these medication interactions is crucial for preventing this serious condition.

Area of Science:

  • Neonatal Medicine
  • Gastroenterology

Background:

  • Spontaneous intestinal perforation (SIP) is a significant concern in extremely low-birth-weight (ELBW) infants.
  • Several factors, including early postnatal steroids (EPS) and early indomethacin use (EUI), are associated with SIP.
  • The combination of EPS and EUI may synergistically increase SIP risk.

Purpose of the Study:

  • To investigate the risk factors contributing to spontaneous intestinal perforation in ELBW infants.
  • To understand the role of medications, particularly early postnatal steroids and indomethacin, in SIP etiology.
  • To explore the impact of polypharmacy on SIP risk in neonates.

Main Methods:

  • Review of existing literature and clinical data on ELBW infants with SIP.
  • Analysis of associations between medication use (EPS, EUI, antenatal indomethacin) and SIP incidence.
  • Evaluation of potential infectious agents and other factors like chorioamnionitis.

Main Results:

  • Early postnatal steroids (EPS) and early indomethacin use (EUI) are strongly associated with SIP.
  • The combined use of EPS and EUI appears to amplify the risk of SIP.
  • Infectious agents (Candida, Staphylococcus epidermidis) and chorioamnionitis are potential contributing factors, though their causal role is less clear.
  • Antenatal indomethacin may also be a risk factor, especially when administered close to birth.

Conclusions:

  • Medication interactions, particularly polypharmacy involving steroids and indomethacin, significantly increase SIP risk in ELBW infants.
  • Further research is needed to elucidate the mechanisms by which these drug interactions lead to SIP.
  • Standardized neonatal care practices may inadvertently amplify SIP risk through the habitual combination of these factors.

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