Neonatal risk factors for functional gastrointestinal disorders in preterm infants in the first year of life

Abstract

Objective: An assessment of functional gastrointestinal disorders (FGIDs) in premature infants in their first year of life and neonatal factors influencing the progression of FGIDs is conducted in this research. Methods: Subjects selected for the retrospective study involved preterm infants being hospitalized in the neonatal department of Northern Jiangsu People’s Hospital from September 2018 to September 2021. Data on neonatal risk factors such as gestational age, gender, birth weight, mode of delivery, feeding pattern, antibiotic administration and addition of probiotics, duration of hospitalization, maternal history of smoking, and mental condition, were all collected and analyzed. FGIDs were diagnosed as per Rome IV criteria and a multivariate logistic regression model has been applied for determining factors linked to it. Results: This study included 988 preterm infants, with 725 (73.4%) having at least one FGID, 449 (45.4%) having infant colic, 411 (41.6%) having infant regurgitation, 237 (24.0%) having infant dyschezia, 190 (19.2%) having functional constipation, and 34 (3.4%) having functional diarrhea throughout the first year of life. There was no evidence identified for infant rumination syndrome and recurrent vomiting syndrome. In total, 263 infants (26.6%) without FGID symptoms were included in the control group. Infant colic and infant regurgitation were found as the most prevalent FGIDs. Further, a higher prevalence of FGIDs was observed in preterm infants with infant colic as well as infant regurgitation in particular as being characterized by a low gestational age (<32w), low birth weight (<1.5kg), cesarean section, formula feeding, neonatal antibiotics use, hospitalization longer than 7 days, and maternal history of smoking. It was found from association analyses that infants exclusively breastfed in their first month of life were at lower risk for regurgitation than those in the control group. Moreover, a significantly low occurrence of functional constipation was found in infants being subjected to probiotics treatment than in the control. Conclusion: Therefore, unnecessary antibiotic use in the neonatal period, cesarean delivery, passive smoking, lack of breastfeeding, along with inappropriate probiotics usage are major risk factors for FGIDs, and their systematic control may be effective in reducing the susceptibility to and prevalence of FGIDs in preterm infants in the first year of life.