Spontaneous Intestinal Perforation in Extremely Premature Infants Exposed to Early Low-Dose Hydrocortisone.

AIM: To assess the occurrence of spontaneous intestinal perforation (SIP) in < 28 weeks' gestational age (GA) infants exposed to early low-dose hydrocortisone (ELH) to reduce the risk of bronchopulmonary dysplasia (BPD). Additionally, the risk of SIP was assessed in infants exposed to early concomitant treatment with ibuprofen for persistent ductus arteriosus (PDA).

METHODS

Observational study in a tertiary neonatal centre preceding and following hydrocortisone implementation. Exposed and non-exposed infants were compared after matching on delivery mode, multiple pregnancy, GA, birthweight, sex and using multivariate logistic regression analysis.

RESULTS

Among 653 infants, 259 (40%) had been exposed to hydrocortisone, and 210 from each group could be paired. Exposed infants had a higher rate of SIP (8.1% vs. 2.9%, OR [95% CI] 2.99 [1.15-7.74]). Early ibuprofen was provided to 110 exposed (52%) and 105 nonexposed (50%). The rate of SIP was higher in exposed infants cotreated with ibuprofen (11.8% vs. 3.8%, OR 3.38 [1.07-10.73]). Logistic regression analysis in the whole cohort confirmed the risk of SIP in infants exposed to concomitant treatment (OR [95% CI] 2.93 [1.24-6.93]).

CONCLUSION

Early concomitant treatment with ELH and ibuprofen is associated with an increased risk of SIP in infants born < 28 weeks.