Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation

• Published in: The Journal of pediatrics Vol. 235; pp. 34 - 41.e1
• Main Authors: Kandraju, Hemasree, Kanungo, Jaideep, Lee, Kyong-Soon, Daspal, Sibasis, Adie, Mohammad Amin, Dorling, Jon, Ye, Xiang Y., Lee, Shoo K., Shah, Prakesh S., Beltempo, Marc, Ting, Joseph, Cieslak, Zenon, Sherlock, Rebecca, Mehrem, Ayman Abou, Toye, Jennifer, Aziz, Khalid, Fajardo, Carlos, Bodani, Jaya, Strueby, Lannae, Seshia, Mary, Louis, Deepak, Alvaro, Ruben, Mukerji, Amit, Da Silva, Orlando, Ng, Eugene, Lemyre, Brigitte, Daboval, Thierry, Khurshid, Faiza, Pelausa, Ermelinda, Barrington, Keith, Lapoint, Anie, Ethier, Guillaume, Drolet, Christine, Piedboeuf, Bruno, Claveau, Martine, St-Hilaire, Marie, Bertelle, Valerie, Masse, Edith, Canning, Roderick, Makary, Hala, Ojah, Cecil, Monterrosa, Luis, Emberley, Julie, Afifi, Jehier, Kajetanowicz, Andrzej, Whittle, Wendy, Morais, Michelle, Dahlgren, Leanne, El-Chaar, Darine, Theriault, Katherine, Ouellet, Annie, Butt, Kimberly, Wood, Stephen, Metcalfe, Amy, O'Quinn, Candace, Pylypjuk, Christy, Boucoiran, Isabelle, Taillefer, Catherine, Crane, Joan, Abenhaim, Haim, Smith, Graeme, Wou, Karen, Chandra, Sue, Ubhi, Jagdeep, Carson, George, Helewa, Michael, Grigoriu, Ariadna, Gratton, Rob, Andrews, James, Melamed, Nir, Burrows, Jason, Taboun, Fatima, Wesson, Lara, MacLellan, Erin, Boss, Hayley, Allen, Vicky
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2021
• Subjects: indomethacin; infant; intestinal perforation; preterm; steroid; CNN; intestinal perforation; preterm; NICU; IVH; SIP; infant; PDA; steroid; indomethacin
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2021.03.012

To evaluate the association of a combined exposure to antenatal steroids and prophylactic indomethacin with the outcome of spontaneous intestinal perforation (SIP) among neonates born at <26 weeks of gestation or <750 g birth weight. We conducted a retrospective study of preterm infants admitted to Canadian Neonatal Network units between 2010 and 2018. Infants were classified into 2 groups based on receipt of antenatal steroids; the latter subgrouped as recent (≤7 days before birth) or latent (>7 days before birth) exposures. The co-exposure was prophylactic indomethacin. The primary outcome was SIP. Multivariable logistic regression analysis was used to calculate aORs. Among 4720 eligible infants, 4121 (87%) received antenatal steroids and 1045 (22.1%) received prophylactic indomethacin. Among infants exposed to antenatal steroids, those who received prophylactic indomethacin had higher odds of SIP (aOR 1.61, 95% CI 1.14-2.28) compared with no prophylactic indomethacin. Subgroup analyses revealed recent antenatal steroids exposure with prophylactic indomethacin had higher odds of SIP (aOR 1.67, 95% CI 1.15-2.43), but latent antenatal steroids exposure with prophylactic indomethacin did not (aOR 1.24, 95% CI 0.48-3.21), compared with the respective groups with no prophylactic indomethacin. Among those not exposed to antenatal steroids, mortality was lower among those who received prophylactic indomethacin (aOR 0.45, 95% CI 0.28-0.73) compared with no prophylactic indomethacin. In preterm neonates of <26 weeks of gestation or birth weight <750 g, co-exposure of antenatal steroids and prophylactic indomethacin was associated with SIP, especially if antenatal steroids was received within 7 days before birth. Among those unexposed to antenatal steroids, prophylactic indomethacin was associated with lower odds of mortality.