Intestinal perforation in very preterm neonates: risk factors and outcomes

Objective:to compare neonatal outcomes of preterm infants (born at <32 weeks’ gestation) with focal/spontaneous intestinal perforation (sip), necrotizing enterocolitis (nec)-related perforation, nec without perforation or no nec/perforation.study design:retrospective cohort study of 17 426 infants admitted to canadian neonatal intensive care units during 2010 to 2013. the primary outcome was a composite of mortality or morbidity (bronchopulmonary dysplasia, severe retinopathy, periventricular leukomalacia or nosocomial infection). association of intestinal perforation with neonatal outcome was evaluated using multivariate logistic regression.result:sip was present in 178 (1.0%) infants, nec-related perforation in 246 (1.4%) and nec without perforation in 538 (3.1%). any intestinal perforation was associated with higher odds of the composite outcome (adjusted odds ratio (aor): 8.21, 95% confidence interval (95% ci) 6.26 to 10.8); however, the odds were significantly lower for focal/sip compared with nec-related perforation (aor: 0.29, 95% ci 0.17 to 0.51).conclusion:of the two types of intestinal perforation, nec-related perforation was associated with the highest risk of an adverse neonatal outcome.