Intestinal perforation in very preterm neonates: risk factors and outcomes.
OBJECTIVE
To compare neonatal outcomes of preterm infants (born at <32 weeks' gestation) with focal/spontaneous intestinal perforation (SIP), necrotizing enterocolitis (NEC)-related perforation, NEC without perforation or no NEC/perforation.


METHODS
Retrospective cohort study of 17,426 infants admitted to Canadian neonatal intensive care units during 2010 to 2013. The primary outcome was a composite of mortality or morbidity (bronchopulmonary dysplasia, severe retinopathy, periventricular leukomalacia or nosocomial infection). Association of intestinal perforation with neonatal outcome was evaluated using multivariate logistic regression.


RESULTS
SIP was present in 178 (1.0%) infants, NEC-related perforation in 246 (1.4%) and NEC without perforation in 538 (3.1%). Any intestinal perforation was associated with higher odds of the composite outcome (adjusted odds ratio (AOR): 8.21, 95% confidence interval (95% CI) 6.26 to 10.8); however, the odds were significantly lower for focal/SIP compared with NEC-related perforation (AOR: 0.29, 95% CI 0.17 to 0.51).


CONCLUSIONS
Of the two types of intestinal perforation, NEC-related perforation was associated with the highest risk of an adverse neonatal outcome.
Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
J
J
Shah
Department of Pediatrics, Foothills Hospital, University of Calgary, Calgary, AB, Canada.
N
N
Singhal
Department of Pediatrics, London Health Sciences Center, University of Western Ontario, London, ON, Canada.
O
O
da Silva
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa University, Ottawa, ON, Canada.
N
N
Rouvinez-Bouali
Department of Pediatrics, Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada.
M
M
Seshia
1] Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada [2] Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.
S K
SK
Lee
1] Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada [2] Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.
P S
PS
Shah
D002170:Canada; D003428:Cross Infection / Q000453:epidemiology*; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000145:classification* / Q000453:epidemiology*; D007363:Intensive Care Units, Neonatal; D007416:Intestinal Perforation / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index