Role of Nutrition in Prevention of Neonatal Spontaneous Intestinal Perforation and Its Complications: A Systematic Review

Olaloye, Oluwabunmi; Swatski, Matthew; Konnikova, Liza

doi:10.3390/nu12051347

Cited by 13 publications

(12 citation statements)

References 56 publications

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“…The pathogenesis of FIP is still unclear [ 26 , 27 ]. Several risk factors like chorioamnionitis or exposure to glucocorticoids and indomethacin have been identified [ 28 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several risk factors like chorioamnionitis or exposure to glucocorticoids and indomethacin have been identified [ 28 – 31 ]. These factors may predispose to FIP through reduced perfusion and collagen synthesis disturbances in specific regions of the intestinal wall [ 27 ]. In our cohort, exposure to glucocorticoids was higher in the lipid enema group without affecting FIP rates.…”

Section: Discussionmentioning

confidence: 99%

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Lipid enemas for meconium evacuation in preterm infants – a retrospective cohort study

Groß

Poets

2021

BMC Pediatr

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Background Enemas are used in preterm infants to promote meconium evacuation, but frequent high-volume enemas might contribute to focal intestinal perforation (FIP). To replace a regime consisting of frequent enemas of varying volume and composition, we implemented a once-daily, low-volume lipid enema (LE) regimen. We investigated its impact on meconium evacuation, enteral nutrition, and gastrointestinal complications in preterm infants. Methods We performed a single-center retrospective study comparing cohorts of preterm infants < 28 weeks gestation or < 32 weeks, but with birth weight < 10th percentile, before and after implementing LE. Outcomes were rates of FIP, necrotizing enterocolitis (NEC), and sepsis. We assessed stooling patterns, early enteral and parenteral nutrition. We used descriptive statistics for group comparisons and logistic regression to identify associations between LE and gastrointestinal complications and to adjust for group imbalances and potential confounders. Exclusion criteria were gastrointestinal malformations or pre-determined palliative care. Results Data from 399 infants were analyzed, 203 before vs. 190 after implementing LE; in the latter period, 55 protocol deviations occurred where infants received no enema, resulting in 3 groups with either variable enemas, LE or no enema use. Rates of FIP and sepsis were 11.9% vs. 6.4% vs. 0.0% and 18.4% vs. 13.5% vs. 14.0%, respectively. NEC rates were 3.0% vs. 7.8% vs. 3.5%. Adjusted for confounders, LE had no effect on FIP risk (aOR 1.1; 95%CI 0.5–2.8; p = 0.80), but was associated with an increased risk of NEC (aOR 2.9; 95%CI 1.0–8.6; p = 0.048). While fewer enemas were applied in the LE group resulting in a prolonged meconium passage, no changes in early enteral and parenteral nutrition were observed. We identified indomethacin administration and formula feeding as additional risk factors for FIP and NEC, respectively (aOR 3.5; 95%CI 1.5–8.3; p < 0.01 and aOR 3.4; 95%CI 1.2–9.3; p = 0.02). Conclusion Implementing LE had no clinically significant impact on meconium evacuation, early enteral or parenteral nutrition. FIP and sepsis rates remained unaffected. Other changes in clinical practice, like a reduced use of indomethacin, possibly affected FIP rates in our cohorts. The association between LE and NEC found here argues against further adoption of this practice. Trial registration Registered at the German Register of Clinical Trials (no. DRKS00024021; Feb 022021).

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“…The pathogenesis of FIP is still unclear [ 26 , 27 ]. Several risk factors like chorioamnionitis or exposure to glucocorticoids and indomethacin have been identified [ 28 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lipid enemas for meconium evacuation in preterm infants – a retrospective cohort study

Groß

Poets

2021

BMC Pediatr

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“…Surgical conditions such as SIP inevitably warrant stopping enteral feeding and the use of parenteral nutrition,39–41 which in turn can result in suboptimal nutrition and hence adverse neurodevelopmental outcomes 42. The age at commencing and reaching full feeds after surgery for SIP is known to vary due to differences in institutional protocols and approaches to surgical intervention 43. It is well known that the use of parenteral nutrition increases the risk of late-onset sepsis, which is known to result in white matter injury,44 CP and other long-term adverse outcomes 45.…”

Section: Discussionmentioning

confidence: 99%

Mortality and neurodevelopmental outcomes of infants with spontaneous intestinal perforation: a systematic review and meta-analysis

Ang

Rath

Tan

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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BackgroundThere is limited information about the mortality and neurodevelopmental outcomes of very preterm infants (<32 weeks) with spontaneous intestinal perforation (SIP).ObjectiveTo explore the association between SIP and neurodevelopmental outcomes and mortality in very preterm infants.Data sourcesMedline, EMBASE, Cochrane Library, EMCARE and MedNar.Study selectionDatabases were searched until September 2021. Studies comparing outcomes of ‘SIP’ versus ‘no SIP or necrotising enterocolitis (NEC)’ were included.Data extractionNeurodevelopmental outcomes at ≥1 year corrected age were extracted as the main outcome measure. Data were pooled separately for adjusted and unadjusted ORs using the random-effects model. The evidence level was assessed using the GRADE (Grading of Recommendations, Assessments, Development and Evaluations) framework.ResultsEighteen cohort studies (13 606 infants) were included. Meta-analysis of unadjusted ORs showed that SIP was significantly associated with increased odds of mortality, cerebral palsy, composite outcome of death or disability, visual impairment and hearing impairment. However, pooling of adjusted ORs (aOR) found significant associations only for mortality (aOR (95% CI) 2.27 (2.07 to 2.49); I2: 0%; four studies (n=10 695)), severe disability (aOR (95% CI) 2.06 (1.38 to 3.08); I2: 0%; two studies (n=321)) and composite outcome of ‘death or disability’ (aOR (95% CI) 2.18 (1.55 to 3.06); I2: 0%; two studies (n=321)). The level of evidence was ‘low’ or ‘very low’.LimitationsLack of information on aORs from many studies.ConclusionsSIP in very preterm infants is associated with higher odds of mortality, severe disability, anddeath or disability.

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“…In this study, con rmed NEC was de ned as NEC stage II and III. Spontaneous intestinal perforation (SIP) was diagnosed by the fellow criteria: (1) no clinical evidence of NEC; (2) isolated intestinal perforation con rmed by surgery and/or pathological examination (without surrounding ischemia, in ammation, pneumatosis, or necrosis); (3) no intestinal anomalies, such as intestinal atresia, volvulus, imperforate anus or traumatic perforations [9,[20][21][22]. Gastrointestinal(GI) anomalies were also con rmed by surgery and/or pathological examination.…”

Section: De Nitionsmentioning

confidence: 99%

“…Despite the continuous development in neonatal intensive care units and improvement of surgical and anesthetic techniques, gastrointestinal perforation is still causing signi cant morbidity and mortality in neonates, especially in preterm groups [1,5,6]. The major causes of GIP in neonates have been ascribed to preterm, low birth weight, bacterial colonization, an early and fast increase in meal volume, and intestinal ischemia according to recent studies [7][8][9][10]. Many theories have been proposed for the pathogenesis of gastrointestinal perforation; however, the etiology is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Preterm Infants with Neonatal Gastrointestinal Perforation: A Retrospective Cohort Study

Yuan

Huang

Wang

2022

Preprint

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Background Gastrointestinal perforation (GIP) among neonates is a major clinical emergency associated with high mortality, which is severe and life-threatening, especially in preterm infants. This study aimed to describe the clinical features of preterm neonatal gastrointestinal perforation and evaluate the potential prognostic factors. Methods A total of 191 preterm neonates with gastrointestinal perforation were included in this retrospective cohort study and assigned to survival and non-survival groups. Information containing clinical and demographic data, laboratory and imaging features, and outcomes were collected and recorded by retrospective medical records review. The independent factors associated with death risk were determined by univariate and multivariate logistic regression analyses. Results The overall mortality in the study cohort was 25.1%. The median age of onset of gastric perforation was 3 days (range: 1–11 days), while the median age of onset of intestinal perforation was 7.5 days (range: 1–30 days). Abdominal distension (184 [96.3%] patients) was the most common symptom, followed by absent bowel sounds (157 [82.2%] patients), lethargy (148 [77.5%] patients), and shortness of breath (60 [59.4%] patients). Finally, three independent mortality risk factors were identified: severe acidosis (OR,7.604; 95% CI, 1.424‒51.910; p = 0.025), shock (5.131; 2.419‒11.266; p < 0.001) and coagulopathy (3.269; 1.511–7.431; p = 0.003). Conclusions Severe acidosis, shock, and coagulopathy are independently and significantly associated with an increased risk of death in preterm infants with neonatal gastrointestinal perforation. The identification of novel risk factors will facilitate the development of therapeutic strategies for preterm neonates with gastrointestinal perforation.

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Role of Nutrition in Prevention of Neonatal Spontaneous Intestinal Perforation and Its Complications: A Systematic Review

Cited by 13 publications

References 56 publications

Lipid enemas for meconium evacuation in preterm infants – a retrospective cohort study

Lipid enemas for meconium evacuation in preterm infants – a retrospective cohort study

Mortality and neurodevelopmental outcomes of infants with spontaneous intestinal perforation: a systematic review and meta-analysis

Prognostic Factors in Preterm Infants with Neonatal Gastrointestinal Perforation: A Retrospective Cohort Study

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