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 in | The Journal of pediatrics Vol. 235; pp. 34 - 41.e1 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.08.2021
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Subjects | |
Online Access | Get full text |
ISSN | 0022-3476 1097-6833 1097-6833 |
DOI | 10.1016/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. |
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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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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33741365$$D View this record in MEDLINE/PubMed |
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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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Copyright | 2021 Elsevier Inc. Copyright © 2021 Elsevier Inc. All rights reserved. |
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CorporateAuthor | Canadian Preterm Birth Network (CPTBN) Investigators Canadian Neonatal Network (CNN) |
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Keywords | CNN intestinal perforation preterm NICU IVH SIP infant PDA steroid indomethacin |
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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 |
URI | https://www.clinicalkey.com/#!/content/1-s2.0-S0022347621002262 https://dx.doi.org/10.1016/j.jpeds.2021.03.012 https://www.ncbi.nlm.nih.gov/pubmed/33741365 https://www.proquest.com/docview/2503448872 |
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