Abstract
OBJECTIVE:
We observed two clusters of spontaneous pneumoperitoneums in extremely low birth weight infants during the use of a protocol for early dexamethasone prophylaxis (EDP) for bronchopulmonary dysplasia from 1996 to 1997. During surgery, focal small bowel perforation (FSBP) was found in eight of nine cases. A retrospective study was designed to identify risk factors for FSBP in these extremely low birth weight infants.
METHODS:
A case-controlled analysis was performed using all infants born weighing <1001 gm and admitted to the University of Washington Medical Center Neonatal Intensive Care Unit during a 13-month period. A total of 51 infants were identified and divided into groups based on treatment or not with dexamethasone and indomethacin. These cohorts were homogeneous for gestational age, birth weight, and perinatal stability. Relative risk and confidence intervals were calculated for each of the comparisons. Routine pathology was performed on all surgical specimens and additional sections were cut and stained for further study.
RESULTS:
Infants who received EDP had a relative risk of perforation that was 12.3 times that of untreated infants. Those treated with indomethacin had a risk that was comparable with that for infants who did not receive indomethacin. Infants who received both EDP and indomethacin tended to have higher rates of pneumoperitoneum than infants who received EDP alone but comprised a cohort too small for valid analysis. The pathology of surgical specimens revealed FSBP with segmental loss of the muscularis externa. There was no evidence of fungal or bacterial infection in any of the surgical specimens.
CONCLUSION: These findings implicate EDP, but not indomethacin, as a significant risk factor for FSBP.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Author information
Authors and Affiliations
Additional information
This work was supported in part by National Institutes of Health GrantHL 19171 SCOR (ADS).
Rights and permissions
About this article
Cite this article
Gordon, P., Rutledge, J., Sawin, R. et al. Early Postnatal Dexamethasone Increases the Risk of Focal Small Bowel Perforation in Extremely Low Birth Weight Infants. J Perinatol 19, 573–577 (1999). https://doi.org/10.1038/sj.jp.7200269
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7200269
This article is cited by
-
Spontaneous intestinal perforation (SIP) will soon become the most common form of surgical bowel disease in the extremely low birth weight (ELBW) infant
Journal of Perinatology (2022)
-
Delayed diagnosis of spontaneous intestinal perforation among very low birth weight neonates: A single center experience
Journal of Perinatology (2019)
-
Intestinal perforation in very preterm neonates: risk factors and outcomes
Journal of Perinatology (2015)
-
Can a national dataset generate a nomogram for necrotizing enterocolitis onset?
Journal of Perinatology (2014)
-
Concurrent use of indomethacin and dexamethasone increases the risk of spontaneous intestinal perforation in very low birth weight neonates
Journal of Perinatology (2006)