Stress-induced gastric findings in critically ill newborn infants: frequency and risk factors.
OBJECTIVE
To evaluate whether infants treated in neonatal intensive care units have stress-induced bleeding from gastrointestinal tract or gastric lesions and to define risk factors for these findings.


METHODS
Part one: retrospective; part two: prospective.


METHODS
Tampere University Hospital, neonatal intensive care unit.


METHODS
In part one, 100 consecutive newborn infants treated in intensive care were retrospectively evaluated for gastrointestinal tract bleeding and risk factors, and in part two 89 gastroscopied and mechanically ventilated infants were prospectively evaluated for further risk factors for gastric mucosal lesions. The statistical evaluation of risk factors was made by multivariate analysis using logistic regression modeling.


RESULTS
Of infants treated in the neonatal intensive care unit 20 % had signs of gastrointestinal bleeding. Mechanical ventilation was the only risk factor (OR = 4.06, 95 % confidence interval 1.21-12.3). In part two, when mechanically ventilated infants were prospectively evaluated, 53 % had remarkable gastric mucosal lesions. The analysis showed three other risk factors: abnormal and delayed delivery and hypotension after birth.


CONCLUSIONS
Newborn infants treated in the intensive care unit had a high frequency of stress-induced gastric hemorrhage with gastric lesions similar to adults and children treated in intensive care. Mechanical ventilation is the main risk factor. Also mode of delivery and hypotension after birth increase the risk of stress-induced gastric lesions. These infants should be the target for prophylactic gastroprotective treatment.
Kuusela
A L
AL
Department of Pediatrics, Tampere University Hospital, Finland. ALeena.Kuusela@sci.fi
Mäki
M
M
Ruuska
T
T
Laippala
P
P
D016638:Critical Illness; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D005773:Gastroscopy; D006801:Humans; D007022:Hypotension / Q000150:complications; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D015999:Multivariate Analysis; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D013315:Stress, Psychological / Q000150:complications* / Q000517:prevention & control