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Lower gastrointestinal tract perforation in preterm infants treated with dexamethasone for bronchopulmonary dysplasia
1Department of Surgery, The Chinese University of Hong Kong, Shatin N. T., Hong Kong.
Insights
High-dose dexamethasone for bronchopulmonary dysplasia can cause ileal perforation in preterm infants. This "silent" gastrointestinal complication requires increased vigilance and prompt abdominal investigations in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Pharmacology
Background:
- Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in preterm infants.
- High-dose dexamethasone is used to treat BPD, but carries risks.
- Gastrointestinal complications of corticosteroids are known, primarily affecting the upper GI tract.
Observation:
- Two cases of ileal perforation in preterm infants receiving high-dose dexamethasone for BPD are presented.
- Ileal perforation, a lower gastrointestinal complication, occurred in these infants.
- Unlike typical presentations, these perforations were "silent" or detected late, initially missed by clinicians.
Findings:
- High-dose dexamethasone treatment for BPD is associated with an increased risk of ileal perforation in preterm infants.
- Lower gastrointestinal tract involvement, specifically ileal perforation, can be a corticosteroid-induced complication.
- Silent or delayed-diagnosis perforations can occur, presenting insidiously rather than with rapid deterioration.
Implications:
- Clinicians must maintain high vigilance for gastrointestinal complications in preterm infants treated with high-dose dexamethasone.
- A low threshold for abdominal investigations is crucial for early detection of ileal perforation.
- This highlights the need to consider lower GI tract risks when using potent corticosteroids 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.