New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations

Attridge, J T; Clark, Reese H.; Walker, M W; Gordon, Phillip V.

doi:10.1038/sj.jp.7211439

Cited by 72 publications

(67 citation statements)

References 9 publications

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“…These and our data of the early administration of ibuprofen within the first 3 days of life and SIP are similar to the observations with indomethacin and SIP suggesting a possible link with drug metabolism (see below). 14,15 Further, our data suggest that the incidence of SIP with ibuprofen is similar to the 2 to 8% incidence reported with indomethacin use previously. 22,24 Although most studies have not reported the timing of perforation in relation to the medical treatment of PDA, Shorter et al 25 noted focal perforation about 7 days following the last dose of indomethacin treatment of PDA.…”

Section: Discussionsupporting

confidence: 68%

“…18 Although NEC and SIP occur in the same population of infants, SIP occurs earlier between 4 to 14 days of age, with a peak incidence between 6 to 9 days and occurs more often in smaller and more immature infants. 14,17,18 The clinical characteristics of infants treated with ibuprofen and who developed SIP were similar to those described previously. 15,17,19,20 Infants in our study with bowel perforation were also of younger GA, had lower birth weight and developed perforation towards the end of first week of life.…”

Section: Discussionsupporting

confidence: 59%

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Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Rao

Bryowsky

Mao³

et al. 2011

J Perinatol

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Objective: To review intestinal complications associated with ibuprofen treatment of patent ductus arteriosus (PDA).Study Design: Data from preterm infants treated with ibuprofen were retrospectively reviewed. w 2 test and Fischer's exact test were used for univariate analyses. Multivariate analyses with logistic regression modeling were used to identify risk factors.Result: One hundred and two infants were treated with ibuprofen for PDA. Nine (9/102, 8.8%) infants developed spontaneous intestinal perforation (SIP), whereas 93/102 (91.2%) did not. The mean (±s.d.) gestational age (GA) at birth in infants with and without SIP was 25.2 ( ± 1.3) vs 27.6 ( ± 2.4) weeks (P ¼ 0.02) and the median (interquartile) length of stay (LOS) was 109.5 (91.0 to 116.5) vs 75.0 (53.0 to 94.5) days (P ¼ 0.002), respectively. The mean ( ± s.d.) age at starting ibuprofen was 3.3 ( ± 1.3) vs 5.8 (±3.5) days in infants with and without SIP, respectively (P ¼ 0.03). In logistic regression analyses, increasing GA and later initiation of ibuprofen treatment were protective against risk of SIP; odds ratio, 95% confidence interval (OR, 95% CI) ¼ 0.26 (0.09 to 0.75), P ¼ 0.01 and 0.63 (0.41 to 0.95), P ¼ 0.03, respectively.Conclusion: Infants at lower GA are at risk of SIP when treated early with ibuprofen for symptomatic PDA.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionsupporting

confidence: 59%

Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Rao

Bryowsky

Mao³

et al. 2011

J Perinatol

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“…All the 13 cases had either respiratory distress or polycythemia before NEC occurred. Eleven of the thirteen were fed before NEC developed, but it is not clear whether the two who were never fed had what today we would define as NEC, or rather had another condition such as SIP [13][14][15] or congenital infarction of the colon. 15 In that report, Thilo et al 12 suggested that to reduce early cases of NEC, feedings should be given more cautiously to neonates who had respiratory distress or polycythemia.…”

Section: Discussionmentioning

confidence: 99%

“…SIP is an example of a condition sometimes confused with NEC. [13][14][15] Human milk feeding programs are not likely to reduce the prevalence of SIP, since many or most cases of SIP occur before the first feeding. 4 Similarly, viral gastroenteritis might be an entity distinct from classical NEC.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

et al. 2008

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Objective: Necrotizing enterocolitis (NEC) is rare during the first week of life; most cases occur after 2 to 4 weeks. We hypothesized that when NEC develops in the first week, certain predisposing factors and feeding practices are identifiable. To test this, we sought to identify every case of NEC diagnosed during the first week within the Intermountain Healthcare system during the most recent 6-year period.Study Design: Data were collected from neonates admitted to any Intermountain Healthcare neonatal intensive care unit (NICU) with a date of birth from 1 January 2001 through 31 December 2006. Electronic and paper records were obtained for all with a diagnosis of NEC (Bell stage XII) within the first 168 h. X-rays, physician notes, nursing records, laboratory reports and operative reports were subjected to critical review to reexamine the diagnosis of NEC. Among those with confirmed NEC, we recorded underlying conditions and every feeding given prior to the diagnosis of NEC. Comparisons were made with patients that did not develop NEC, yet were cared for in the same NICUs, during the same period of time, and of the same gestational ages.Result: A total of 28 neonates were identified electronically as having NEC during the first week. Critical review confirmed this in 21, but 5 were determined at laparotomy to have had spontaneous intestinal perforation, and 2 others were found on surgical reports to have had a congenital infarction of the colon. Total 20 of the 21 confirmed cases developed NEC while in a NICU being treated for another condition. The exception was a small-for-gestational-age neonate in a well baby nursery. Compared to 6100 controls, the 21 with early NEC were more likely to have had a meconium-positive test for illicit drug exposure (P<0.005), early onset sepsis (P<0.034) and respiratory distress (P<0.039). They were less likely than case-controls to have been fed human milk (P ¼ 0.003) and were more likely to have been fed formula exclusively (P ¼ 0.019).None who were fed human milk exclusively developed early NEC. Twelve of the twenty-one were fed (by gavage or bottle) amounts exceeding the upper limit of volumes taken by breastfed neonates. Conclusion:We speculate that the prevalence of NEC during the first week could be reduced by identifying at-risk patients, feeding them human milk exclusively for the first week and using feeding volumes that do not exceed that taken by healthy breastfed neonates.

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“…The increase risk of chronic lung disease (CLD) is thought to be secondary to its inhibitory effects on surfactant production and stimulatory effects on proinflammatory mediators in the lung [5]. Postnatal indomethacin use is associated with intestinal perforation and acute renal dysfunction in premature infants [2,14]. More recently antenatal indomethacin has been associated with PVL in premature infants (Amin SB, in press).…”

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confidence: 99%

Multiple Courses of Indomethacin and Neonatal Outcomes in Premature Infants

2007

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The objective of this retrospective cohort study was to determine patent ductus arteriosus (PDA) closure rate with multiple short courses (three doses) of postnatal indomethacin and compare neonatal outcomes in infants who received two versus three courses of indomethacin for PDA closure. Infants <34 weeks' gestational age born between January 2000 and December 2004 at the University of Maryland Medical Center and who received two or more short courses of indomethacin were included. Outcome measures were ductal closure rate and neonatal outcomes. Of 61 infants who were identified to have received two or more courses of indomethacin, 26 infants closed their ductus after the second course (response rate, 42%). Of the 35 infants who failed ductal closure after two courses, 11 infants had their ductus ligated and 23 received a third course of indomethacin. Of 23 who received a third course, 10 closed their ductus (response rate, 43%). There was no significant difference in the incidence of chronic lung disease, severe retinopathy of prematurity, necrotizing enterocolitis, renal function, or mortality between infants who received two and those who received three courses of indomethacin. Infants exposed to three courses of indo-methacin had a statistically nonsignificant increased incidence of periventricular leukomalacia (p = 0.08; adjusted odds ratio = 4.8; 95% CI, 0.8-30) and remained in the hospital for a longer duration (p = 0.02) compared to infants exposed to two courses of indomethacin. We conclude that multiple courses of indomethacin may be associated with a ductal closure. However, the requirement for a third course may be associated with an increased risk of periventricular leukomalacia. Indomethacin, a potent inhibitor of prostaglandin synthesis, has been routinely used to treat patent ductus arteriosus (PDA) in premature infants [10,28]. However, approximately 20%-40% of premature infants have residual luminal flow or fail to close after the initial short course (three doses given every 12 h) of indomethacin [4,12,15,28]. If the ductus fails to close after the initial course of indomethacin, surgical ligation of PDA and additional indomethacin treatment are two available options for the management of persistent PDA [20,24]. It is not clear whether surgical ligation or multiple courses of indo-methacin should be the preferred treatment of PDA that fails to close after the initial short course of indomethacin [7,19,25]. The medical literature suggests that additional indomethacin treatment is unlikely to produce ductus closure for premature infants, if there is persistent Doppler evidence of ductal flow within 24 h after completion of the initial short course of indomethacin [17]. Contrary to this limited evidence, a recent survey of Neonatal Fellowship Program Directors in the United States reported that multiple courses of indomethacin, up to three, are commonly used for persistent PDA, after the initial course of indo-methacin [1]. This survey also reported that there is wide variation in the ma...

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New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations

Cited by 72 publications

References 9 publications

Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

Multiple Courses of Indomethacin and Neonatal Outcomes in Premature Infants

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