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Published on: June 16, 2022
Spontaneous intestinal perforation among very preterm infants in China: a multicenter cohort study
Weiying Mao1, Siyuan Jiang1, Chun Shen2
1Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Insights
Spontaneous intestinal perforation (SIP) affects about 1% of very preterm infants in China, significantly increasing their risk of death and serious health issues. Over 90% of these infants required laparotomy for surgical treatment, highlighting the need for better prevention and management strategies.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Public health in neonatology
Background:
- Spontaneous intestinal perforation (SIP) is a critical surgical condition in preterm infants.
- Limited data exists on SIP prevalence, mortality, and morbidities in very preterm infants (<32 weeks gestational age) in China.
Purpose of the Study:
- To determine the prevalence, treatment, and outcomes of SIP in very preterm infants in China.
- To analyze the association between SIP and neonatal outcomes.
Main Methods:
- Retrospective cohort study of infants born between 24+0-31+6 weeks gestational age from January 2019 to December 2020.
- Inclusion criteria: infants admitted to neonatal intensive care units within seven days of birth within the Chinese Neonatal Network.
- Outcomes assessed: survival without major morbidities, mortality, late-onset sepsis, and bronchopulmonary dysplasia using multivariate logistic regression.
Main Results:
- 1.0% (150/15,814) of very preterm infants developed SIP, with the highest incidence in the earliest gestations (2.4% in 24+0-25+6 weeks).
- SIP was associated with significantly lower survival without major morbidities (29.3% vs. 59.2%) and increased risks of death (aOR 3.36), late-onset sepsis (aOR 2.10), and bronchopulmonary dysplasia (aOR 2.49).
- Surgical intervention, primarily laparotomy (92.6%), was common, though 18.7% received no surgical treatment.
Conclusions:
- SIP affects approximately 1% of very preterm infants in China, carrying substantial risks for mortality and morbidity.
- The majority of SIP cases require surgical intervention, predominantly laparotomy.
- There is an urgent need for evidence-based strategies to prevent and manage SIP in this vulnerable population.
Background:
Spontaneous intestinal perforation (SIP) is one of the most serious surgical bowel conditions affecting preterm infants. There are limited data on the mortality and morbidities of very preterm infants [VPIs, <32 weeks' gestational age (GA)] with SIP in China. The study aimed to describe the prevalence, treatment, and outcomes of SIP among VPIs in China.
Methods:
This retrospective cohort study included all infants born at 24+0-31+6 weeks GA from January 1, 2019, to December 31, 2020, and admitted within seven days after birth to the neonatal intensive care units in the Chinese Neonatal Network. The primary outcome was survival without major morbidities. The association between SIP and neonatal outcomes was evaluated using multivariate logistic regression controlling for possible confounders.
Results:
Out of the 15,814 enrolled infants, 150 (1.0%) developed SIP with a median onset age of four (IQR 2-6) days. Infants with GA 24+0-25+6 weeks had the highest incidence of SIP (13/532, 2.4%), followed by those with GA 26+0-27+6 weeks (22/2,005, 1.1%), 28+0-29+6 weeks (44/5,269, 0.8%) and 30+0-31+6 weeks (71/8,008, 0.9%). Ten SIP cases were lost to follow-up with unknown survival status and 41 (29.3%) of the remaining 140 infants with SIP died during hospitalization. Only 29.3% of infants with SIP survived without major morbidities, significantly lower than those without SIP (59.2%; P<0.01). Multivariate analysis revealed SIP was associated with a higher risk of overall death (adjusted OR 3.36; 95% CI: 1.85 to 6.08), late-onset sepsis (adjusted OR 2.10; 95% CI: 1.02 to 4.31), and bronchopulmonary dysplasia (adjusted OR 2.49; 95% CI: 1.44 to 4.30). Among all infants with SIP, 28 (18.7%) did not receive any surgical intervention. Laparotomy was provided to 113 (92.6%) of the remaining 122 infants, solely (84/122, 68.9%) or following peritoneal drainage (29/122, 23.8%), while nine (7.4%) infants underwent peritoneal drainage only.
Conclusions:
Around 1% of VPIs in China developed SIP, associated with increased risk of mortality and morbidities. Over 90% of VPIs with SIP underwent laparotomy as initial or subsequent surgical treatment. Effective and evidence-based strategies are needed for the prevention and management of SIP.
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