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Intestinal perforation in very preterm neonates: risk factors and outcomes

Abstract

Objective:

To compare neonatal outcomes of preterm infants (born at <32 weeks’ gestation) with focal/spontaneous intestinal perforation (SIP), necrotizing enterocolitis (NEC)-related perforation, NEC without perforation or no NEC/perforation.

Study Design:

Retrospective cohort study of 17 426 infants admitted to Canadian neonatal intensive care units during 2010 to 2013. The primary outcome was a composite of mortality or morbidity (bronchopulmonary dysplasia, severe retinopathy, periventricular leukomalacia or nosocomial infection). Association of intestinal perforation with neonatal outcome was evaluated using multivariate logistic regression.

Result:

SIP was present in 178 (1.0%) infants, NEC-related perforation in 246 (1.4%) and NEC without perforation in 538 (3.1%). Any intestinal perforation was associated with higher odds of the composite outcome (adjusted odds ratio (AOR): 8.21, 95% confidence interval (95% CI) 6.26 to 10.8); however, the odds were significantly lower for focal/SIP compared with NEC-related perforation (AOR: 0.29, 95% CI 0.17 to 0.51).

Conclusion:

Of the two types of intestinal perforation, NEC-related perforation was associated with the highest risk of an adverse neonatal outcome.

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Acknowledgements

We thank the staff of the Canadian Neonatal Network Coordinating Centre for their hard work, Mr Junmin Yang for statistical support and Dr Ruth Warre for providing editorial support during preparation of the manuscript. Although no funding was received specifically for this study, the Canadian Neonatal Network (CNN) received organizational support from the CNN Coordinating Centre, which is based at the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital, Toronto, Ontario, Canada. MiCare is supported by funding from the Canadian Institutes of Health Research and Mount Sinai Hospital, Toronto.

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Appendix

Appendix

Site investigators for the Canadian Neonatal Network

Prakesh S Shah (Director, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario; Adele Harrison, Victoria General Hospital, Victoria, British Columbia; Anne Synnes, British Columbia Children’s Hospital, Vancouver, British Columbia; Zenon Cieslak, Royal Columbian Hospital, New Westminster, British Columbia; Todd Sorokan, Surrey Memorial Hospital, Surrey, British Columbia; Wendy Yee, Foothills Medical Centre, Calgary, Alberta; Khalid Aziz, Royal Alexandra Hospital, Edmonton, Alberta; Zarin Kalapesi, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, Royal University Hospital, Saskatoon, Saskatchewan; Mary Seshia, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; Ruben Alvaro, St Boniface General Hospital, Winnipeg, Manitoba; Sandesh Shivananda, Hamilton Health Sciences Centre, Hamilton, Ontario; Orlando Da Silva, London Health Sciences Centre, London, Ontario; Chuks Nwaesei, Windsor Regional Hospital, Windsor, Ontario; Kyong-Soon Lee, Hospital for Sick Children, Toronto, Ontario; Prakesh Shah, Mount Sinai Hospital, Toronto, Ontario; Michael Dunn, Sunnybrook Health Sciences Centre, Toronto, Ontario; Nicole Rouvinez-Bouali, Children’s Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario; Kimberly Dow, Kingston General Hospital, Kingston, Ontario; Ermelinda Pelausa, Jewish General Hospital, Montréal, Québec; Keith Barrington, Hôpital Sainte-Justine, Montréal, Québec; Christine Drolet, Centre Hospitalier Universitaire de Québec, Sainte Foy, Patricia Riley, Montréal Children’s Hospital, Montréal, Québec; Daniel Faucher, Royal Victoria Hospital, Montréal, Québec; Valerie Bertelle, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Rody Canning, Moncton Hospital, Moncton, New Brunswick; Barbara Bulleid, Dr Everett Chalmers Hospital, Fredericton, New Brunswick; Cecil Ojah and Luis Monterrosa, Saint John Regional Hospital, Saint John, New Brunswick; Akhil Deshpandey, Janeway Children’s Health and Rehabilitation Centre, St John’s, Newfoundland; Jehier Afifi, IWK Health Centre, Halifax, Nova Scotia; Andrzej Kajetanowicz, Cape Breton Regional Hospital, Sydney, Nova Scotia; Shoo K Lee (Chairman, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario.

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Shah, J., Singhal, N., da Silva, O. et al. Intestinal perforation in very preterm neonates: risk factors and outcomes. J Perinatol 35, 595–600 (2015). https://doi.org/10.1038/jp.2015.41

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