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Lower gastrointestinal tract perforation in preterm infants treated with dexamethasone for bronchopulmonary dysplasia
Insights
High-dose dexamethasone for bronchopulmonary dysplasia can cause ileal perforation in preterm infants. Clinicians should maintain vigilance for "silent" gastrointestinal perforations in these vulnerable patients.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Pharmacology
Background:
- High-dose corticosteroid use, specifically dexamethasone, is common in managing bronchopulmonary dysplasia in preterm infants.
- While gastroduodenal complications of corticosteroids are recognized, lower gastrointestinal tract involvement, such as ileal perforation, is less commonly known.
- Previous cases often presented with rapid deterioration, but silent perforations can also occur.
Purpose of the Study:
- To describe two cases of ileal perforation in preterm infants treated with high-dose dexamethasone.
- To highlight the potential for "silent" lower gastrointestinal perforations in this patient population.
- To emphasize the need for increased clinical awareness and prompt investigation.
Main Methods:
- Case report description of two preterm infants.
- Review of clinical presentation, treatment with high-dose dexamethasone for bronchopulmonary dysplasia, and subsequent development of ileal perforation.
- Radiographic and clinical assessment for gastrointestinal complications.
Main Results:
- Two preterm infants receiving high-dose dexamethasone for bronchopulmonary dysplasia developed ileal perforation.
- The perforations were initially detected on routine radiographs, presenting as "silent" events without rapid clinical deterioration.
- These cases illustrate that lower gastrointestinal tract perforation is a potential complication of high-dose dexamethasone therapy.
Conclusions:
- Ileal perforation is a serious, albeit less recognized, complication of high-dose dexamethasone treatment in preterm infants with bronchopulmonary dysplasia.
- A high index of suspicion and a low threshold for abdominal investigations are crucial for early detection.
- Vigilance is essential to prevent delayed diagnosis and management of corticosteroid-induced gastrointestinal perforations in neonates.
Abstract:
Two cases of ileal perforation in preterm infants treated with high-dose dexamethasone for bronchopulmonary dysplasia are described. Corticosteroid-induced gastroduodenal haemorrhage or perforation has been well documented, but less known to most clinicians is that the lower gastrointestinal tract can also be involved. Unlike previous reported cases in which affected infants deteriorated rapidly and became moribund within hours of onset of symptoms, "silent" perforations detected on routine radiograph or escaping clinical recognition until at an advanced stage can be the initial presentation. The need for greater vigilance and a low threshold for abdominal investigations are emphasised in preterm infants treated with dexamethasone.