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Risk factors and epidemiology of spontaneous intestinal perforation among infants born at 22–24 weeks’ gestational age

Journal of Perinatology volume 44, pages 94–99 (2024)Cite this article

Subjects

Abstract

Objective

To describe the epidemiology, risk factors, and timing of spontaneous intestinal perforation (SIP) among infants born at 22–24 weeks’ gestational age (GA).

Study design

Observational cohort study among infants born at 22–24 weeks’ GA in 446 neonatal intensive care units.

Results

We identified 9712 infants, of whom 379 (3.9%) developed SIP. SIP incidence increased with decreasing GA (P < 0.001). Antenatal magnesium (odds ratio (OR) 1.42; 95% confidence interval (CI), 1.09–1.85), antenatal indomethacin (OR 1.40; 95% CI, 1.06–1.85), postnatal indomethacin (OR 1.61; 95% CI, 1.23–2.11), and postnatal hydrocortisone exposure (OR 2.02; 95% CI 1.50–2.73) were associated with SIP. Infants who lost 15–20% (OR 1.77; 95% CI, 1.28–2.44) or >20% (OR 2.04; 95% CI, 1.46–2.85) of birth weight had higher odds of SIP than infants with weight loss <10%.

Conclusions

Antenatal magnesium exposure, antenatal indomethacin exposure, postnatal hydrocortisone exposure, postnatal indomethacin exposure, and weight loss ≥15% were associated with SIP.

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Fig. 1: Percentage of 22-24 week gestational age infants with spontaneous intestinal perforation (SIP) by year.
Fig. 2: Occurrence of spontaneous intestinal perforation (SIP) amony 22-24 week gestational age infants by postnatal day.

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Code availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This work was funded under the National Institute of Child Health and Human Development (NICHD) contract (HHSN275201 000003I) for the Pediatric Trials Network (PI DKB Jr). This work was also funded by the Biogen Foundation and Duke Clinical Research Institute’s R25 Summer Training in Academic Research (STAR) Program (grant #5R25HD076475-10). The content is solely the authors' responsibility and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA

    Pavan V. Thakkar, Chloe-Ann B. Detwiler, Julia G. Henegar, Jai R. Narayan, Melanie Perez-Romero, Ciara M. Strausser, Daniel K. Benjamin Jr, Kanecia O. Zimmerman, P. Brian Smith, Rachel G. Greenberg & Ryan Kilpatrick

  2. Duke University School of Medicine, Durham, NC, USA

    Kent F. Sutton

  3. Pediatrix Center for Research Education, Quality, and Safety, Sunrise, FL, USA

    Reese H. Clark

  4. Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    Daniel K. Benjamin Jr, Kanecia O. Zimmerman, Ronald N. Goldberg, Noelle Younge, David Tanaka, P. Brian Smith, Rachel G. Greenberg & Ryan Kilpatrick

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  1. Pavan V. Thakkar
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Contributions

RK conceptualized and designed the study, supervised the drafting of the manuscript, interpreted the data analyses, and reviewed and revised the manuscript. RK had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis. PVT contributed to the conception and design of the study, drafted the initial manuscript, and contributed to the data interpretation and reviewing and revising the manuscript. RGG supervised the conception and design of the study, contributed to the data interpretation and the critical revision of the manuscript for important intellectual content. KFS contributed to the data interpretation and the manuscript drafting. C-ABD contributed to the data interpretation and the manuscript drafting. JGH contributed to the data interpretation and the manuscript drafting. JRN contributed to the data interpretation and the manuscript drafting. MP-R contributed to the data interpretation and the manuscript drafting. CMS contributed to the data interpretation and the manuscript drafting. RHC contributed to the data interpretation and the critical revision of the manuscript for important intellectual content. DKB contributed to the data interpretation and the critical revision of the manuscript for important intellectual content. KOZ contributed to the data interpretation and the critical revision of the manuscript for important intellectual content. RNG contributed to the data interpretation and the critical revision of the manuscript for important intellectual content. NY contributed to the data interpretation and the critical revision of the manuscript for important intellectual content. DT contributed to the data interpretation and the critical revision of the manuscript for important intellectual content. PBS contributed to the design of the study, data interpretation, and the critical revision of the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Rachel G. Greenberg.

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Competing interests

PT, C-AD, JGH, JN, MP-R, and CS declare support from a National Institute of Child Health and Human Development grant. DKB reports consultancy for Allergan, Melinta Therapeutics, Sun Pharma Advanced Research Co. KOZ reports funding from the National Institutes of Health (NIH) and US Food and Drug Administration (FDA). RGG has received support from the industry for research services (https://dcri.org/about-us/conflict-of-interest/). KFS, RNG, NY, DT, PBS, RC, and RK have nothing to disclose.

Ethics approval

The Duke University Institutional Review Board (Durham, NC USA) provided permission to conduct this analysis (Protocol ID: Pro00111546)

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High school or college students (Pavan V. Thakkar, Chloe-Ann B. Detwiler, Julia G. Henegar, Jai R. Narayan, Melanie Perez-Romero, and Ciara M. Strausser are affiliated with the Duke Clinical Research Institute’s R25 Summer Training in Academic Research (STAR) Program.

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Thakkar, P.V., Sutton, K.F., Detwiler, CA.B. et al. Risk factors and epidemiology of spontaneous intestinal perforation among infants born at 22–24 weeks’ gestational age. J Perinatol 44, 94–99 (2024). https://doi.org/10.1038/s41372-023-01782-6

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