Ann Pediatr Res | Volume 6, Issue 2 | Research Article | Open Access
Woei Bing Poon1,2,3*, Srabani Bharadwaj1,2,3 and Mary Grace S Tan1,3
1Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore 3Lee Kong Chian, School of Medicine, Singapore
*Correspondance to: Woei Bing Poon
Fulltext PDFIntroduction: Spontaneous Intestinal Perforation (SIP) is one of the most concerning complication of PDA treatment in VLBW infants with a relative lack of studies quantifying the risk factors. Objective: To create a predictive risk model for SIP, which will assist in weighing the pros and cons of PDA treatment in VLBW infants. Methods: A retrospective cohort study of VLBW infants comparing SIP infants with non-SIP controls was conducted to obtain significant risk factors. The impacts of SIP in terms of mortality, BPD, IVH and ROP were assessed. Results: The 389 VLBW infants were included, with a 2.3% incidence of SIP. Risk factors for SIP were lower gestations, higher need for resuscitation at birth, hypotension, PDA medication and culture proven late onset sepsis. A clinical risk model was created to assess PDA treatment risk. If VLBW babies were not medically treated with intravenous ibuprofen, the risk of SIP was completely precluded. However, if PDA medications were started, the use of Hosmer and Lemeshow testing created a risk model incorporating the 4 risk factors of gestation, hypotension, culture proven sepsis and extensive resuscitation. An AUROC of 90.4% was achieved. If a PDA is medically treated with intravenous ibuprofen, the presence of 2 or more of the 4 risk factors will render the risk high at more 10%. A clinical risk prediction score model derived can also be developed, with risk scores of 100 or less as low risk, 101 to 125 assigned as moderate risk and above 125 as high risk. Amongst infants with SIP, mortality was 44.4% and SIP was associated with BPD requiring postnatal steroids, IVH, severe IVH and cholestasis. No association was found with ROP. Conclusion: SIP is a complication of PDA medical treatment associated with high risk of mortality and morbidities. Risk modeling based on VLBW infants who were given PDA medications, and using the 4 major risk factors of gestation, hypotension, extensive resuscitation and culture proven sepsis, can help inform the clinical decision on whether to proceed with treatment.
Neonatal department; Birthweight; Infants
Poon WB, Bharadwaj S, Tan MGS. A Clinical Risk Model for Spontaneous Intestinal Perforation during Patent Ductus Arteriosus Medical Treatment for Very Low Birthweight Infants. Ann Pediatr Res. 2022;6(2):1068..