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Unexplained gut symptoms in extremely preterm infants are associated with gastrointestinal dysfunction at 5.5 years
Júlíus Kristjánsson1,2, Karin Sävman1,2, Kerstin Allvin1,2
1Department of Paediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Extremely preterm infants experiencing significant gastrointestinal (GI) symptoms in the neonatal period face a higher risk of developing long-term GI dysfunction. This increased probability persists even without major abdominal surgery or necrotising enterocolitis.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Perinatal Medicine
Background:
- Extremely preterm infants often experience gastrointestinal (GI) complications.
- The long-term implications of neonatal GI symptoms in this population require further investigation.
- Identifying risk factors for later GI dysfunction is crucial for improved infant outcomes.
Purpose of the Study:
- To determine if considerable neonatal GI symptoms in extremely preterm infants predict later GI dysfunction.
- To assess if this association is independent of major abdominal surgery or necrotising enterocolitis.
- To evaluate secondary outcomes including respiratory, neurological, and growth abnormalities.
Main Methods:
- A retrospective case-control study design was employed.
- Extremely preterm neonates (mean gestational age 25w 4d) with upper GI contrast series (UGI) were identified as cases.
- Cases were matched with controls for sex and gestational age, with GI dysfunction at 5.5 years as the primary outcome.
Main Results:
- Infants with neonatal GI symptoms had a significantly increased odds ratio (3.8) for developing GI dysfunction at 5.5 years.
- Associated neonatal morbidities like sepsis and patent ductus arteriosus were more frequent in cases.
- No significant differences were observed in respiratory, neurological, or growth outcomes at 5.5 years.
Conclusions:
- Unexplained neonatal GI symptoms in extremely preterm infants are linked to a higher likelihood of developing later GI dysfunction.
- This association is not attributable to other common neonatal morbidities.
- Clinical vigilance for long-term GI issues is recommended for extremely preterm infants with neonatal GI symptoms.
Aim:
To evaluate whether extremely preterm infants with considerable gastrointestinal (GI) symptoms during the neonatal period, but without major abdominal surgery or necrotising enterocolitis, had an increased probability of developing GI dysfunction later in life.
Methods:
A retrospective, case-control study on extremely preterm neonates that underwent an upper gastrointestinal contrast series (UGI) between 2012 and 2017, with UGI used as a marker of considerable GI symptoms. Controls were matched for sex and gestational age. The primary outcome was GI dysfunction requiring ongoing medical support at 5.5 years. Secondary outcomes included respiratory, neurological and growth abnormalities.
Results:
Thirty-three patients and 66 controls were included; mean gestational age at birth was 25w + 4d. Cases had an odds ratio of 3.8 (p = 0.005; 95% CI = 1.47-9.82) for developing GI dysfunction at 5.5 years after adjusting for confounders. Neonatal morbidities of sepsis, patent ductus arteriosus and hypothyroidism were more common in cases (p < 0.05). No differences were seen in secondary outcomes at 5.5 years of age.
Conclusion:
Extremely preterm infants with unexplained GI symptoms during the neonatal period had increased odds of developing GI dysfunction later in life, which was not explained by other morbidities. We suggest appropriate attention concerning later GI dysfunction in these patients.
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