Long-term outcomes of very low birth weight infants with spontaneous intestinal perforation: A retrospective case-matched cohort study

Abstract

Background: Spontaneous intestinal perforation (SIP) is an intestinal complication that occurs in very ill preterms. We investigated whether SIP survivors have worse neurodevelopmental and gastrointestinal outcomes and a poorer quality of life than controls. Methods: A retrospective case-matched cohort study was performed involving infants treated for SIP in a NICU between August 1994 and April 2014. Controls and SIP patients were matched to gestational age, gender, and birth period. Medical records were reviewed. Telephone surveys were conducted to evaluate the medical condition, quality of life (PedsQL™ 4.0), neuropsychiatric and gastrointestinal outcome. McNemar's and Wilcoxon tests were performed, and generalized linear models were computed. Results: Forty-nine SIP patients were included. The percentages of children with multiple disabilities (40% vs. 17%, OR = 3.3) and requiring physiotherapy (86% vs. 60%, OR = 4.77) were higher in the SIP group than in the control group. Intraventricular hemorrhage (IVH) led to a worse neurodevelopmental outcome regardless of SIP (OR = 8.79 for disability), and female gender was a protective factor against disability (OR = 0.06). Reported quality of life and gastrointestinal comorbidities did not differ between the two groups. Conclusion: SIP survivors tend to be at risk of multiple disabilities. IVH and female gender influence the neurodevelopmental outcome regardless of SIP.

Predictors of Mortality Among Very Low Birth Weight Infants With Gastrointestinal Perforation

“…In the present study, 26.2% of infants died as a result of this complication, which is consistent with the range of 20-40% previously reported. 6 We identified 3 factors at the time of diagnosis that correlated with an increased risk of death in VLBW infants with GI perforation: portal venous gas on abdominal radiography, metabolic acidosis, and elevated lactate. Insight into the predictive nature of these characteristics might result in better prognostic capabilities, albeit if not altering current treatment strategies.…”

“…3 However, the infant mortality rate among VLBW infants has been reported to be more than 100 times that of infants with birth weights of 2500 g or more. 4,6 This is unsurprising, given that this population has an elevated risk of mortality due to chronic lung disease, infection, gastrointestinal (GI) disease, intraventricular hemorrhage (IVH), and other comorbidities. 5 One complication that can increase the risk of death is GI perforation, which affects approximately 2-3% of the VLBW population.…”

“…5 One complication that can increase the risk of death is GI perforation, which affects approximately 2-3% of the VLBW population. 6 The 2 most common etiologies of GI perforation are spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC). Some clinicians believe these diseases to be distinct entities, but this remains controversial.…”

Mortality and neurodevelopmental outcomes of infants with spontaneous intestinal perforation: a systematic review and meta-analysis

“…Advances in perinatal and neonatal intensive care have improved the survival of very preterm and extremely preterm infants. Spontaneous intestinal perforation (SIP) is emerging as a leading cause of pneumoperitoneum, with a reported incidence of up to 8% in extremely low birth weight (ELBW <1000 g) and 2%–3% in very low birth weight (VLBW <1500 g) infants 1–3. SIP is often confused with perforation associated with necrotising enterocolitis (NEC), a potentially life-threatening condition in preterm infants with significant mortality and morbidity, including long-term neurodevelopmental impairment 4 5.…”

“…However, the results of previous studies assessing the health burden of SIP are contradictory in this context 6. Some of the studies, including a recent large national database study, have reported a significant association between SIP and adverse neurodevelopmental outcomes and mortality 1 6 7. In contrast, few studies have reported no association between SIP and impaired neurodevelopment 8 9…”