Abstract
To identify factors contributing to neonatal intestinal perforation (IP), all cases of IP not associated with necrotizing enterocolitis (NEC) or bowel obstruction referred between 1975-1982 were reviewed. Eighteen babies met these criteria. Three met classic criteria for spontaneous perforation. Fifteen were receiving cycled mechanical ventilation by either NP or FM at the time of perforation. Perforations were localized to the stomach in 7, duodenum in 1, jejunum in 1 and ileum in 6. Gestational ages of mechanically ventilated infants ranged from 26-40 weeks (mean=30), weights from 890-2810 grams (mean=1500) and 5 minute Apgar from 1-10 (mean=6). The most common primary diagnosis was RDS. Twelve infants were males and two were enterally fed prior to perforation. Two babies died. All the cases and 57% of the controls were ventilated by NP or FM. To determine if the type of ventilation contributed to perforations, a matched case-control analysis was performed. Each NP or FM ventilated case was matched with four controls for gestation, age at perforation and Apgar scores. Using the Mantel-Haenzel estimate of odds ratio and test for significance for matched pairs, children with intestinal perforation were much more likely than controls to have been ventilated by either NP or FM; odds ratio =23.8 (X2MH = 35.6, p < 0.001). We conclude that mechanical ventilation with NP or FM is associated with an unnecessary risk to babies when compared to ventilation with ET tube.
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Garland, J., Nelson, D., Rice, T. et al. INTESTINAL PERFORATIONS SECONDARY TO MECHANICAL VENTILATION WITH NASAL PRONGS (NP) OR FACE MASK (FM). Pediatr Res 18 (Suppl 4), 323 (1984). https://doi.org/10.1203/00006450-198404001-01381
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DOI: https://doi.org/10.1203/00006450-198404001-01381