Antenatal Steroids, Prophylactic Indomethacin, and the Risk of Spontaneous Intestinal Perforation - 22/08/23
, Heather Weydig, MD 2, Luc P. Brion, MD 2, Myra H. Wyckoff, MD 2, Tamara I. Arnautovic, MD, MHS 1, Noelle Younge, MD 3, William Oh, MD 1, Dhuly Chowdhury, MS, MBA 4, Martin Keszler, MD 1, Abhik Das, PhD 4for the
National Institute of Child Health and Human Development Neonatal Research Network5
Abstract |
Objective |
To estimate if the odds of spontaneous intestinal perforation (SIP) are increased when antenatal steroids (ANS) given close to delivery are combined with indomethacin on day 1 after birth (Indo-D1).
Study design |
A retrospective cohort study using the Neonatal Research Network (NRN) database of inborn infants, gestational age 220-286 weeks or birth weight of 401-1000 g, born between January 1, 2016 and December 31, 2019, and surviving >12 hours. The primary outcome was SIP through 14 days. Time of last ANS dose prior to delivery was analyzed as a continuous variable (using 169 hours for durations >168 hours or no steroid exposure). Associations between ANS, Indo-D1, and SIP were obtained from a multilevel hierarchical generalized linear mixed model after covariate adjustment. This yielded aOR and 95% CI.
Results |
Of 6851 infants, 243 had SIP (3.5%). ANS exposure occurred in 6393 infants (93.3%) and IndoD1 was given to 1863 infants (27.2%). The time (median, IQR) from last dose of ANS to delivery was 32.5 hours (6-81) vs 37.1 hours (7-110) for infants with or without SIP, respectively (P = .10). Indo-D1 was given to 51.9 vs 26.3% of infants with SIP vs no SIP, respectively (P < .0001). Adjusted analysis indicated no interaction between time of last ANS dose and Indo-D1 for SIP (P = .7). Indo-D1 but not ANS was associated with increased odds of SIP (aOR: 1.73, 1.21-2.48, P = .003).
Conclusion |
The odds of SIP were increased after receipt of Indo-D1. Exposure to ANS prior to Indo-D1 was not associated with an increase in SIP.
Le texte complet de cet article est disponible en PDF.Keywords : intestinal injury, extreme prematurity, small intestinal rupture
Abbreviations : ANS, Indo-D1, IVH, NRN, PDA, SGA, SIP
Plan
| Sources of Financial Assistance: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources, and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network Generic Database (recruitment 1/1/2016 – 12/31/2019) through cooperative agreements. While NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. |
|
| Prior presentation: Abstract presented as a platform presentation at the Pediatric Academic Societies meeting 2021. |
Vol 259
Article 113457- août 2023 Retour au numéro
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