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. 2023 Aug:259:113457.
doi: 10.1016/j.jpeds.2023.113457. Epub 2023 May 11.

Antenatal Steroids, Prophylactic Indomethacin, and the Risk of Spontaneous Intestinal Perforation

Abbot R Laptook  1 , Heather Weydig  2 , Luc P Brion  2 , Myra H Wyckoff  2 , Tamara I Arnautovic  3 , Noelle Younge  4 , William Oh  3 , Dhuly Chowdhury  5 , Martin Keszler  3 , Abhik Das  5 ; National Institute of Child Health and Human Development Neonatal Research Network  6
Affiliations

Antenatal Steroids, Prophylactic Indomethacin, and the Risk of Spontaneous Intestinal Perforation

Abbot R Laptook et al. J Pediatr. 2023 Aug.

Abstract

Objective: To estimate if the odds of spontaneous intestinal perforation (SIP) are increased when antenatal steroids (ANS) given close to delivery are combined with indomethacin on day 1 after birth (Indo-D1).

Study design: A retrospective cohort study using the Neonatal Research Network (NRN) database of inborn infants, gestational age 220-286 weeks or birth weight of 401-1000 g, born between January 1, 2016 and December 31, 2019, and surviving >12 hours. The primary outcome was SIP through 14 days. Time of last ANS dose prior to delivery was analyzed as a continuous variable (using 169 hours for durations >168 hours or no steroid exposure). Associations between ANS, Indo-D1, and SIP were obtained from a multilevel hierarchical generalized linear mixed model after covariate adjustment. This yielded aOR and 95% CI.

Results: Of 6851 infants, 243 had SIP (3.5%). ANS exposure occurred in 6393 infants (93.3%) and IndoD1 was given to 1863 infants (27.2%). The time (median, IQR) from last dose of ANS to delivery was 32.5 hours (6-81) vs 37.1 hours (7-110) for infants with or without SIP, respectively (P = .10). Indo-D1 was given to 51.9 vs 26.3% of infants with SIP vs no SIP, respectively (P < .0001). Adjusted analysis indicated no interaction between time of last ANS dose and Indo-D1 for SIP (P = .7). Indo-D1 but not ANS was associated with increased odds of SIP (aOR: 1.73, 1.21-2.48, P = .003).

Conclusion: The odds of SIP were increased after receipt of Indo-D1. Exposure to ANS prior to Indo-D1 was not associated with an increase in SIP.

Keywords: extreme prematurity; intestinal injury; small intestinal rupture.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest

Figures

Figure 1:
Figure 1:
Available sample after application of inclusion and exclusion criteria. Infants with missing data for prophylactic indomethacin (see Methods, sample size) were removed after application of inclusion and exclusion criteria. GA: gestational age, BW: birth weight, NEC: necrotizing enterocolitis, SIP: spontaneous intestinal perforation, ANS: antenatal steroids, Indo: prophylactic indomethacin
See this image and copyright information in PMC

Comment in

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