TY - JOUR
T1 - Antenatal Steroids, Prophylactic Indomethacin, and the Risk of Spontaneous Intestinal Perforation
AU - National Institute of Child Health and Human Development Neonatal Research Network
AU - Laptook, Abbot R.
AU - Weydig, Heather
AU - Brion, Luc P.
AU - Wyckoff, Myra H.
AU - Arnautovic, Tamara I.
AU - Younge, Noelle
AU - Oh, William
AU - Chowdhury, Dhuly
AU - Keszler, Martin
AU - Das, Abhik
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/8
Y1 - 2023/8
N2 - Objective: To estimate if the odds of spontaneous intestinal perforation (SIP) are increased when antenatal steroids (ANS) given close to delivery are combined with indomethacin on day 1 after birth (Indo-D1). Study design: A retrospective cohort study using the Neonatal Research Network (NRN) database of inborn infants, gestational age 220-286 weeks or birth weight of 401-1000 g, born between January 1, 2016 and December 31, 2019, and surviving >12 hours. The primary outcome was SIP through 14 days. Time of last ANS dose prior to delivery was analyzed as a continuous variable (using 169 hours for durations >168 hours or no steroid exposure). Associations between ANS, Indo-D1, and SIP were obtained from a multilevel hierarchical generalized linear mixed model after covariate adjustment. This yielded aOR and 95% CI. Results: Of 6851 infants, 243 had SIP (3.5%). ANS exposure occurred in 6393 infants (93.3%) and IndoD1 was given to 1863 infants (27.2%). The time (median, IQR) from last dose of ANS to delivery was 32.5 hours (6-81) vs 37.1 hours (7-110) for infants with or without SIP, respectively (P =.10). Indo-D1 was given to 51.9 vs 26.3% of infants with SIP vs no SIP, respectively (P <.0001). Adjusted analysis indicated no interaction between time of last ANS dose and Indo-D1 for SIP (P =.7). Indo-D1 but not ANS was associated with increased odds of SIP (aOR: 1.73, 1.21-2.48, P =.003). Conclusion: The odds of SIP were increased after receipt of Indo-D1. Exposure to ANS prior to Indo-D1 was not associated with an increase in SIP.
AB - Objective: To estimate if the odds of spontaneous intestinal perforation (SIP) are increased when antenatal steroids (ANS) given close to delivery are combined with indomethacin on day 1 after birth (Indo-D1). Study design: A retrospective cohort study using the Neonatal Research Network (NRN) database of inborn infants, gestational age 220-286 weeks or birth weight of 401-1000 g, born between January 1, 2016 and December 31, 2019, and surviving >12 hours. The primary outcome was SIP through 14 days. Time of last ANS dose prior to delivery was analyzed as a continuous variable (using 169 hours for durations >168 hours or no steroid exposure). Associations between ANS, Indo-D1, and SIP were obtained from a multilevel hierarchical generalized linear mixed model after covariate adjustment. This yielded aOR and 95% CI. Results: Of 6851 infants, 243 had SIP (3.5%). ANS exposure occurred in 6393 infants (93.3%) and IndoD1 was given to 1863 infants (27.2%). The time (median, IQR) from last dose of ANS to delivery was 32.5 hours (6-81) vs 37.1 hours (7-110) for infants with or without SIP, respectively (P =.10). Indo-D1 was given to 51.9 vs 26.3% of infants with SIP vs no SIP, respectively (P <.0001). Adjusted analysis indicated no interaction between time of last ANS dose and Indo-D1 for SIP (P =.7). Indo-D1 but not ANS was associated with increased odds of SIP (aOR: 1.73, 1.21-2.48, P =.003). Conclusion: The odds of SIP were increased after receipt of Indo-D1. Exposure to ANS prior to Indo-D1 was not associated with an increase in SIP.
KW - extreme prematurity
KW - intestinal injury
KW - small intestinal rupture
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U2 - 10.1016/j.jpeds.2023.113457
DO - 10.1016/j.jpeds.2023.113457
M3 - Article
C2 - 37172814
AN - SCOPUS:85162169063
SN - 0022-3476
VL - 259
JO - Journal of Pediatrics
JF - Journal of Pediatrics
M1 - 113457
ER -