Abstract 1067 Poster Session I, Saturday, 5/1 (poster 71)

BACKGROUND: Meta-analysis has demonstrated that postnatal corticosteroid therapy (STER) of preterm neonates decreases the risk of chronic lung disease (CLD). Indomethacin (IND) is widely used in preterm neonates to close the patent ductus arteriosus (PDA). However, both STER and IND may cause adverse gastrointestinal effects and we hypothesized that when both therapies were given to the same neonate this risk would increase.

AIM: The aim of this study was to compare the incidence of (NECSURG) in neonates < 28 wks gestational age (ga) exposed to STER, IND and both STER and IND (STER/IND), with those who were not exposed. We sought information on the incidence of abdominal surgery as a possible adverse effect and specifically the incidence of surgery for NEC (NECSURG), a clearly defined endpoint which is prospectively collected in our database.

METHODS: Ten NICUs in the state of N.S.W., Australia prospectively collected data from 1992-1997 on 1349 neonates < 28 wks ga whose mean ga and birthweight were 26 wks and 856 gms, respectively. Data collection included whether a PDA was treated with IND, whether CLD was treated with postnatal steroids, and whether surgery was performed for radiologically proven or operatively confirmed NEC (NECSURG). NECSURG was coded according to the ICD.9.CM classification.

RESULTS: Sixty nine neonates had NECSURG the commonest procedures being: partial resection of small intestine (SI), n=27; resection of cecum and terminal ileum, n=8; ileostomy/colostomy, n=6; laparotomy, n=6; hemicolectomy, n=6; resection of transverse colon, n=5; partial excision of large intestine, n=5; other surgical procedures, n=6. Results are given in the table.

Table 1 No caption
Full size table

CONCLUSIONS: We conclude that combined therapy with STER and IND significantly increases the risk of surgery for NEC when compared to a group of infants who received neither therapy (p = 0.004). Individual therapy with STER and IND did not significantly increase the risk for NECSURG, although there were trends in that direction (p = 0.071, and p = 0.059, respectively).