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

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 admitt...

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Published inThe 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
LanguageEnglish
Published United States Elsevier Inc 01.08.2021
Subjects
Online AccessGet full text
ISSN0022-3476
1097-6833
1097-6833
DOI10.1016/j.jpeds.2021.03.012

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Abstract 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.
AbstractList 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.
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.OBJECTIVETo 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.STUDY DESIGNWe 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.RESULTSAmong 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.CONCLUSIONSIn 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.
Author Wesson, Lara
Bodani, Jaya
Lee, Shoo K.
Smith, Graeme
Lemyre, Brigitte
Whittle, Wendy
Metcalfe, Amy
Melamed, Nir
Burrows, Jason
O'Quinn, Candace
Shah, Prakesh S.
Louis, Deepak
Taillefer, Catherine
Daspal, Sibasis
Makary, Hala
Pylypjuk, Christy
Ojah, Cecil
Kanungo, Jaideep
Drolet, Christine
Kajetanowicz, Andrzej
Morais, Michelle
MacLellan, Erin
Da Silva, Orlando
Butt, Kimberly
Allen, Vicky
Ye, Xiang Y.
Wood, Stephen
Pelausa, Ermelinda
Boss, Hayley
Adie, Mohammad Amin
Emberley, Julie
Sherlock, Rebecca
Canning, Roderick
Dahlgren, Leanne
Daboval, Thierry
Mukerji, Amit
El-Chaar, Darine
Lapoint, Anie
Taboun, Fatima
Boucoiran, Isabelle
Gratton, Rob
Ouellet, Annie
Beltempo, Marc
Masse, Edith
Lee, Kyong-Soon
Piedboeuf, Bruno
Dorling, Jon
Abenhaim, Haim
Barrington, Keith
Chandra, Sue
St-Hilaire, Marie
Ethier, Guillaume
Fajardo, Carlos
Wou, Karen
Grigoriu, Ariadna
Mehrem, Ayman Abou
Kandraju, Hemasree
Toye, Jennifer
Ubhi, Jagdeep
Monterrosa, Luis
Helewa, Michael
Claveau, Martine
Andrews, James
Crane, Joan
Ng, Eugene
Ting, Joseph
Aziz, Khalid
Afifi, Jehier
Strueby,
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ContentType Journal Article
Contributor Wesson, Lara
Bodani, Jaya
Smith, Graeme
Lemyre, Brigitte
Whittle, Wendy
Metcalfe, Amy
Melamed, Nir
Burrows, Jason
O'Quinn, Candace
Louis, Deepak
Taillefer, Catherine
Makary, Hala
Pylypjuk, Christy
Ojah, Cecil
Drolet, Christine
Kajetanowicz, Andrzej
Morais, Michelle
MacLellan, Erin
Da Silva, Orlando
Butt, Kimberly
Allen, Vicky
Wood, Stephen
Pelausa, Ermelinda
Boss, Hayley
Emberley, Julie
Sherlock, Rebecca
Canning, Roderick
Dahlgren, Leanne
Daboval, Thierry
Mukerji, Amit
El-Chaar, Darine
Lapoint, Anie
Taboun, Fatima
Boucoiran, Isabelle
Gratton, Rob
Ouellet, Annie
Beltempo, Marc
Masse, Edith
Piedboeuf, Bruno
Abenhaim, Haim
Barrington, Keith
Chandra, Sue
St-Hilaire, Marie
Ethier, Guillaume
Fajardo, Carlos
Wou, Karen
Grigoriu, Ariadna
Mehrem, Ayman Abou
Toye, Jennifer
Ubhi, Jagdeep
Monterrosa, Luis
Helewa, Michael
Claveau, Martine
Andrews, James
Crane, Joan
Ng, Eugene
Ting, Joseph
Aziz, Khalid
Afifi, Jehier
Strueby, Lannae
Cieslak, Zenon
Alvaro, Ruben
Khurshid, Faiza
Theriault, Katherine
Seshia, Mary
Bertelle, Valerie
Carson, George
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Keywords CNN
intestinal perforation
preterm
NICU
IVH
SIP
infant
PDA
steroid
indomethacin
Language English
License Copyright © 2021 Elsevier Inc. All rights reserved.
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SubjectTerms indomethacin
infant
intestinal perforation
preterm
steroid
Title Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation
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https://dx.doi.org/10.1016/j.jpeds.2021.03.012
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