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Risk factors for surgical intestinal disorders in VLBW infants: Case-control study
Hiroomi Okuyama1, Satoko Ohfuji2, Masahiro Hayakawa3
1Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Insights
This study identified distinct risk factors for necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI) in very low-birthweight infants. Different prevention strategies are needed for each surgical intestinal disorder.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Perinatal medicine
Background:
- Very low-birthweight infants (VLBWI) face elevated risks for surgical intestinal disorders like necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI).
- Understanding disease-specific risk factors is crucial for targeted prevention and management in this vulnerable population.
Purpose of the Study:
- To identify and analyze disease-specific risk factors for surgical intestinal disorders in very low-birthweight infants.
- To differentiate etiological pathways for NEC, FIP, and MRI in VLBWI.
Main Methods:
- A retrospective, multicenter case-control study involving 150 VLBWI who underwent laparotomy for intestinal disorders.
- Two matched controls per case were selected based on gestational age and birthweight.
- Conditional logistic regression and multivariate models were used to calculate odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Multivariate analysis revealed specific risk factors: female sex, respiratory distress syndrome, and patent ductus arteriosus for NEC; outborn delivery for FIP; twin pregnancy, PROM, and maternal steroid use for MRI.
- No significant differences in gestational age or birthweight were observed between cases and controls.
Conclusions:
- Distinct risk factors for NEC, FIP, and MRI suggest unique etiologies for each condition.
- Tailored preventive strategies are necessary for each specific surgical intestinal disorder in VLBWI.
Background:
Very low-birthweight (VLBW) infants (VLBWI) are at increased risk for surgical intestinal disorders including necrotizing enterocolitis (NEC), focal intestinal perforation (FIP) and meconium-related ileus (MRI). The aim of this study was to identify disease-specific risk factors for surgical intestinal disorders in VLBWI.
Methods:
A retrospective multicenter case-control study was conducted at 11 institutes. We reviewed VLBWI who underwent laparotomy for intestinal disorders including perforation and intractable bowel obstruction. The surgical disorders were classified into four categories (NEC, FIP, MRI, others) based on the macroscopic findings at operation. In order to identify risk factors, two matched controls for each subject were chosen based on gestational age and birthweight. OR and 95%CI were calculated using a conditional logistic regression model and a multivariate model.
Results:
A total of 150 cases (NEC, n = 44; FIP, n = 47; MRI, n = 42; others, n = 17) and 293 controls were identified. The cases and controls were similar in terms of gestational age and birthweight (cases/controls, 26.7 ± 2.5/26.5 ± 2.6 weeks; 790 ± 256/795 ± 257 g). On multivariate modeling, disease-specific risk factors were as follows: female (OR, 0.23; 95%CI: 0.06-0.89), respiratory distress syndrome (OR, 35.7; 95%CI: 2.48-514) and patent ductus arteriosus (OR, 10.9; 95%CI: 1.51-79.3) for NEC; outborn delivery (OR, 5.47; 95%CI: 1.48-20.2) for FIP; and twin pregnancy (OR, 4.25; 95%CI: 1.06-17.1), PROM (OR, 6.85; 95%CI: 1.33-35.4) and maternal steroid (OR, 0.23; 95%CI: 0.07-0.79) for MRI.
Conclusions:
Different risk factors were identified for NEC, FIP and MRI, suggesting that each disease has a different etiology, and that different strategies are required to prevent these diseases.
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