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

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Original research
Mortality and neurodevelopmental outcomes of infants with spontaneous intestinal perforation: a systematic review and meta-analysis
  1. Ju Li Ang1,2,
  2. Chandra Prakash Rath1,2,
  3. Herr Tan1,2,
  4. Sanjay Patole2,3,
  5. Shripada C Rao1,3
  1. 1 Neonatology, Perth Children's Hospital, Nedlands, Western Australia, Australia
  2. 2 Neonatology, King Edward memorial hospital For Women, Subiaco, Western Australia, Australia
  3. 3 Paediatrics, The University of Western Australia School of Medicine, Nedlands, Western Australia, Australia
  1. Correspondence to Dr Chandra Prakash Rath, King Edward Memorial Hospital for Women Perth, Subiaco, Australia; drcprath{at}gmail.com

Abstract

Background There is limited information about the mortality and neurodevelopmental outcomes of very preterm infants (<32 weeks) with spontaneous intestinal perforation (SIP).

Objective To explore the association between SIP and neurodevelopmental outcomes and mortality in very preterm infants.

Data sources Medline, EMBASE, Cochrane Library, EMCARE and MedNar.

Study selection Databases were searched until September 2021. Studies comparing outcomes of ‘SIP’ versus ‘no SIP or necrotising enterocolitis (NEC)’ were included.

Data extraction Neurodevelopmental 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.

Results Eighteen 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’.

Limitations Lack of information on aORs from many studies.

Conclusions SIP in very preterm infants is associated with higher odds of mortality, severe disability, and death or disability.

  • neonatology
  • infant development
  • intensive care units, neonatal

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/archdischild-2022-324157

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors JLA performed an independent literature search and data collection, carried out initial analyses, drafted the initial manuscript and revised the final draft of the manuscript. CPR conceptualised and designed the study, performed an independent literature search and data collection, co-authored and supervised the initial and final draft of the manuscript. TH assisted in data compilation drafted and summarised information in tables. SCR supervised data interpretation and handling of the meta-analysis software and supervised the initial and final draft of the manuscript. SP acted as a referee author in case of discrepancy between other authors and critically reviewed the manuscript for important intellectual content. CPR is gurantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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