PT  - JOURNAL ARTICLE
AU  - Rajan Wadhawan
AU  - William Oh
AU  - Betty R Vohr
AU  - Shampa Saha
AU  - Abhik Das
AU  - Edward F Bell
AU  - Abbott Laptook
AU  - Seetha Shankaran
AU  - Barbara J Stoll
AU  - Michele C Walsh
AU  - Rose Higgins
TI  - Spontaneous intestinal perforation in extremely low birth weight infants: association with indometacin therapy and effects on neurodevelopmental outcomes at 18–22 months corrected age
AID  - 10.1136/archdischild-2011-300659
DP  - 2013 Mar 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F127--F132
VI  - 98
IP  - 2
4099  - http://fn.bmj.com/content/98/2/F127.short
4100  - http://fn.bmj.com/content/98/2/F127.full
SO  - Arch Dis Child Fetal Neonatal Ed2013 Mar 01; 98
AB  - Background Spontaneous intestinal perforation (SIP) is associated with the use of postnatal glucocorticoids and indometacin in extremely low birth weight (ELBW) infants. The authors hypothesised: 1) an association of SIP with the use of antenatal steroids (ANS) and indometacin either as prophylaxis for intraventricular hemorrhage (IVH) (P Indo) or for treatment of PDA (Indo/PDA) and 2) an increased risk of death or abnormal neurodevelopmental outcomes in infants with SIP at 18–22 months corrected age. Design/Methods The authors retrospectively identified ELBW infants with SIP in the Neonatal Research Network's generic database. Unadjusted analysis identified the differences in maternal, neonatal and clinical variables between infants with and without SIP. Logistic regression analysis identified the adjusted OR for SIP with reference to ANS, P Indo and Indo/PDA. Neurodevelopmental outcomes were assessed among survivors at 18–22 months corrected age. Results Indo/PDA was associated with an increased risk of SIP (adjusted OR 1.61; 95% CI 1.25 to 2.08), while P Indo and ANS were not. SIP was independently associated with an increased risk of death or neurodevelopmental impairment (NDI) (adjusted OR 1.85; 95% CI 1.32 to 2.60) and NDI among survivors (adjusted OR 1.75, 95% CI 1.20 to 2.55). Conclusion Indometacin used for IVH prophylaxis and ANS were not associated with the occurrence of SIP in ELBW infants. Indometacin used for treatment of symptomatic PDA was however associated with an increased risk of SIP. ELBW infants with SIP have an increased risk of poor neurodevelopmental outcomes.