Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation.

Abstract

OBJECTIVE:

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.

STUDY DESIGN:

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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Hemasree Kandraju, Jaideep Kanungo, Kyong-Soon Lee, Sibasis Daspal, Mohammad Amin Adie, Jon Dorling, Xiang Y Ye, Shoo K Lee, Prakesh S Shah, Canadian Neonatal Network (CNN), Canadian Preterm Birth Network (CPTBN) Investigators
• Journal: The Journal of pediatrics (J Pediatr) Vol. 235 Pg. 34-41.e1 (08 2021) ISSN: 1097-6833 [Electronic] United States
• PMID: 33741365 (Publication Type: Journal Article, Comment)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Steroids
• Indomethacin

Topics

• Brain Injuries
• Canada
• Female
• Gestational Age
• Humans
• Indomethacin (adverse effects)
• Infant
• Infant, Newborn
• Infant, Premature
• Intestinal Perforation (chemically induced, epidemiology, prevention & control)
• Pregnancy
• Retrospective Studies
• Steroids