Spontaneous intestinal perforation in premature infants: a national study

Elgendy, Marwa M; Othman, Hasan F.; Heis, Farah; Qattea, Ibrahim; Aly, Hany

doi:10.1038/s41372-021-00990-2

Cited by 25 publications

(16 citation statements)

References 20 publications

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“…Pooling of unadjusted ORs from studies showed that SIP was significantly associated with mortality, CP, composite outcome (death or disability), visual impairment and hearing impairment (figures 2–6 and table 4). One study with a large sample size had a major effect on the mortality outcome 6. Pooling of adjusted ORs found a significant association between SIP and mortality, severe disability and the composite outcome of death or disability (figures 2, 4 and 7, and table 4).…”

Section: Resultsmentioning

confidence: 98%

“…The initial search yielded 1966 results, from which 18 studies were included based on the selection criteria 1 6–9 13 19–31. The study selection process is shown in the PRISMA flow diagram (figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Compared with medical NEC, preterm infants with surgical NEC or SIP have more severe brain injury on MRI at term corrected gestational age 52. Studies have reported that SIP is associated with a higher incidence of intraventricular haemorrhage, chronic lung disease, periventricular leukomalacia and nosocomial infections compared with infants who did not have NEC or SIP 1 6 24 28. Such complications are known to increase the risk of adverse neurodevelopmental outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…SIP is usually considered a relatively less severe condition than NEC. However, the results of previous studies assessing the health burden of SIP are contradictory in this context 6. Some of the studies, including a recent large national database study, have reported a significant association between SIP and adverse neurodevelopmental outcomes and mortality 1 6 7.…”

Section: Introductionmentioning

confidence: 99%

“…However, the results of previous studies assessing the health burden of SIP are contradictory in this context 6. Some of the studies, including a recent large national database study, have reported a significant association between SIP and adverse neurodevelopmental outcomes and mortality 1 6 7. In contrast, few studies have reported no association between SIP and impaired neurodevelopment 8 9…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Postoperative Outcomes, and Growth and Brain Injury Outcomes in Spontaneous Intestinal Perforation vs Surgical Necrotizing Enterocolitis in Preterm Infants

Garg,

Lett,

Ansari

et al. 2023

Indian Pediatr

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Wide use of broad-spectrum antibiotics in very low birth weight infants with spontaneous focal intestinal perforation—is it really justified?

Butzer,

Faust,

Oberthuer

et al. 2024

Infection

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Purpose Very low birth weight (VLBW) infants are at a risk of spontaneous focal intestinal perforation (FIP). Treatment includes supportive care, antibiotics, and drainage with/without surgery. Broad-spectrum antibiotic agents like carbapenems are applied frequently, although their use is not well-supported by the limited evidence of causal pathogens. We hypothesize that the use of carbapenems may not be necessary in VLBW infants with FIP. Our primary objective was to evaluate the antimicrobial use in VLBW infants with FIP in a cohort of the German Neonatal Network (GNN). The secondary objective was to characterize a subset in detail as a benchmark for future targets of stewardship. Methods Data on VLBW infants with FIP was collected prospectively within the GNN, a collaboration of 68 neonatal intensive care units (NICU). With regards to the primary objective, patient characteristics and antimicrobial treatment were extracted from the predefined GNN database. To address our secondary objective, an additional on-site assessment of laboratory and microbiological culture results were performed. Results In the GNN cohort, 613/21,646 enrolled infants (2.8%) developed FIP requiring surgery. They were frequently treated with carbapenems (500/613 (81.6%)) and vancomycin (497/613 (81.1%)). In a subset of 124 VLBW infants, 77 (72.6%) had proof of gram-positive bacteria in the abdominal cavity, coagulase-negative staphylococci (CoNS) predominantly. Despite the low prevalence of gram-negative bacteria (n = 6 (4.8%)), the combination of meropenem and vancomycin was prescribed most frequently (n = 96 (78.0%)). Conclusion The use of carbapenems as broad-spectrum antimicrobials agents might not be justified in most VLBW infants with FIP. Knowledge on the development of the neonatal gut microbiota, local resistance patterns and individual microbiological findings should be taken into consideration when implementing antimicrobial stewardship programs (ASPs).

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Spontaneous intestinal perforation in premature infants: a national study

Cited by 25 publications

References 20 publications

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

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

Postoperative Outcomes, and Growth and Brain Injury Outcomes in Spontaneous Intestinal Perforation vs Surgical Necrotizing Enterocolitis in Preterm Infants

Wide use of broad-spectrum antibiotics in very low birth weight infants with spontaneous focal intestinal perforation—is it really justified?

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