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Risk factors and epidemiology of spontaneous intestinal perforation among infants born at 22-24 weeks' gestational

Pavan V Thakkar1, Kent F Sutton2, Chloe-Ann B Detwiler1

  • 1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|September 27, 2023
PubMed

Insights

Spontaneous intestinal perforation (SIP) affects nearly 4% of extremely premature infants. Risk factors include antenatal magnesium, indomethacin, postnatal hydrocortisone, and significant birth weight loss.

Area of Science:

  • Neonatalogy
  • Perinatology
  • Pediatric Surgery

Background:

  • Spontaneous intestinal perforation (SIP) is a critical surgical emergency in neonates.
  • Infants born at extremely low gestational ages (22-24 weeks) are particularly vulnerable.
  • Understanding SIP epidemiology and risk factors is crucial for improving outcomes.

Purpose of the Study:

  • To investigate the incidence, risk factors, and timing of SIP in infants born at 22-24 weeks' gestational age.
  • To identify specific antenatal and postnatal exposures associated with SIP development.
  • To analyze the impact of birth weight loss on SIP risk.

Main Methods:

  • An observational cohort study was conducted across 446 neonatal intensive care units.
  • Data were collected on 9712 infants born between 22-24 weeks' gestational age.
  • Statistical analysis identified associations between various factors and SIP incidence.

Main Results:

  • The overall incidence of SIP was 3.9% (379 infants).
  • SIP incidence demonstrated an inverse correlation with gestational age (P < 0.001).
  • Associated risk factors included antenatal magnesium, antenatal indomethacin, postnatal indomethacin, postnatal hydrocortisone, and birth weight loss of ≥15%.

Conclusions:

  • Antenatal magnesium, antenatal indomethacin, postnatal hydrocortisone, postnatal indomethacin, and significant birth weight loss (≥15%) are associated with increased SIP risk.
  • These findings highlight critical periods and exposures that warrant closer monitoring and potential intervention.
  • Further research may focus on preventative strategies for high-risk infants.
Abstract

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