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Eur J Pediatr Surg 2015; 25(06): 520-525
DOI: 10.1055/s-0034-1396418
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Spontaneous Intestinal Perforation and Necrotizing Enterocolitis: A 16-Year Retrospective Study from a Single Center

Etienne Suply
1   Department of Chirurgie Pédiatrique, CHU Nantes, Nantes, France
,
Marc-David Leclair
1   Department of Chirurgie Pédiatrique, CHU Nantes, Nantes, France
,
Michel Neunlist
2   Institut des Maladies de l'Appareil Digestif DHU 2020, INSERM U913, Nantes, France
,
Jean-Christophe Roze
3   Department of Neonatology, CHU Nantes, Nantes, France
,
Cyril Flamant
3   Department of Neonatology, CHU Nantes, Nantes, France
› Author Affiliations
Further Information

Publication History

17 July 2014

24 October 2014

Publication Date:
02 February 2015 (online)

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Abstract

Background Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are serious abdominal conditions that affect preterm infants but are poorly understood. This single-center retrospective study was performed to identify the factors associated with NEC and SIP.

Methods This study involved 3,464 preterm infants recruited over 16 years. A total of 136 NEC and 24 SIP were analyzed and adjusted odds ratios (aOR) were determined by logistic regression.

Results Compared with the controls, NEC was associated with a Z-score for birth weight lower than –1 (aOR = 2.1 [1.1–3.9], p = 0.02) and lower than –2 (aOR = 4.4 [1.8–10.4], p < 0.01). NEC was associated with gestational ages of less than 31 weeks and with breech presentations (aOR = 1.5 [1.0–2.3], p = 0.03). In contrast, compared with the controls, SIP was associated with gestational ages of less than 26 weeks (aOR = 17.4 [3.1–96.2], p < 0.001) and multiple pregnancy (aOR = 2.9 [1.2–6.9], p = 0.02). Rates of mortality and cerebral lesions were higher in patients with NEC (25.0 and 13.2%, respectively) than with the controls (10.1 and 6.9%, respectively) and similar between patients with SIP (12.5 and 8.3%, respectively) and the controls.

Conclusion NEC and SIP differed in risk factors and prognosis. Early distinction of SIP from NEC could impact on surgical decision.

Keywords

necrotizing enterocolitis - spontaneous intestinal perforation - risk factors - very low-birth-weight infants
 

  • References

  • 1 Blakely ML, Lally KP, McDonald S , et al; NEC Subcommittee of the NICHD Neonatal Research Network. Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg 2005; 241 (6) 984-989 , discussion 989–994
    CrossrefPubMedGoogle Scholar
  • 2 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 3 Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011; 364 (3) 255-264
    CrossrefPubMedGoogle Scholar
  • 4 Uceda JE, Laos CA, Kolni HW, Klein AM. Intestinal perforations in infants with a very low birth weight: a disease of increasing survival?. J Pediatr Surg 1995; 30 (9) 1314-1316
    CrossrefPubMedGoogle Scholar
  • 5 Attridge JT, Clark R, Walker MW, Gordon PV. New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol 2006; 26 (2) 93-99
    CrossrefPubMedGoogle Scholar
  • 6 Adesanya OA, O'Shea TM, Turner CS, Amoroso RM, Morgan TM, Aschner JL. Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1.  year of age. J Perinatol 2005; 25 (9) 583-589
    CrossrefPubMedGoogle Scholar
  • 7 Michel JL, Harper L, Alessandri JL , et al. Peritoneal needle suction for intestinal perforation in the preterm neonate. Eur J Pediatr Surg 2004; 14 (2) 85-88
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Cass DL, Brandt ML, Patel DL, Nuchtern JG, Minifee PK, Wesson DE. Peritoneal drainage as definitive treatment for neonates with isolated intestinal perforation. J Pediatr Surg 2000; 35 (11) 1531-1536
    CrossrefPubMedGoogle Scholar
  • 9 Gordon PV, Swanson JR, Attridge JT, Clark R. Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria?. J Perinatol 2007; 27 (11) 661-671
    CrossrefPubMedGoogle Scholar
  • 10 Nakajima Y, Masaoka N, Yamamoto T. Obstetrical risk factors for focal intestinal perforation in very low birth weight infants. J Perinat Med 2011; 39 (2) 179-184
    PubMedGoogle Scholar
  • 11 Sharma R, Hudak ML, Tepas III JJ , et al. Prenatal or postnatal indomethacin exposure and neonatal gut injury associated with isolated intestinal perforation and necrotizing enterocolitis. J Perinatol 2010; 30 (12) 786-793
    CrossrefPubMedGoogle Scholar
  • 12 Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2013; 4: CD003481
    PubMedGoogle Scholar
  • 13 Ragouilliaux CJ, Keeney SE, Hawkins HK, Rowen JL. Maternal factors in extremely low birth weight infants who develop spontaneous intestinal perforation. Pediatrics 2007; 120 (6) e1458-e1464
    CrossrefPubMedGoogle Scholar
  • 14 Been JV, Lievense S, Zimmermann LJI, Kramer BW, Wolfs TG. Chorioamnionitis as a risk factor for necrotizing enterocolitis: a systematic review and meta-analysis. J Pediatr 2013; 162 (2) 236-42.e2
    CrossrefPubMedGoogle Scholar
  • 15 Cotten CM, Taylor S, Stoll B , et al; NICHD Neonatal Research Network. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009; 123 (1) 58-66
    CrossrefPubMedGoogle Scholar
  • 16 Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR. Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 2011; 159 (5) 720-725
    CrossrefPubMedGoogle Scholar