Author Of 1 Presentation
A PREDICTIVE RISK MODEL FOR SPONTANEOUS INTESTINAL PERFORATION TO ASSIST WITH PDA TREATMENT DECISIONS IN VLBW INFANTS
Abstract
Background
Spontaneous intestinal perforation (SIP) is one of the most important complication of PDA treatment in VLBW infants with a relative lack of studies quantifying the risk factors
Objectives
To create a predictive PDA risk model for SIP to assist in weighing the pros and cons of PDA treatment.
Methods
A 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, ROP and growth parameters were assessed.
Results
389 VLBW infants were included, with 9 having SIP (2.3%). Risk factors for SIP were lower birthweights, more resuscitation at birth, hypotension, PDA medication and culture proven late onset sepsis.
A risk model was created to assess PDA treatment risk. If VLBW babies were not treated with PDA medication, the risk of SIP was completely precluded. However, if PDA medications were started, the presence of any 2 of 3 major risk factors, namely hypotension, extensive birth resuscitation or culture proven LOS would render the risk unacceptably high.
If SIP developed, mortality was 44.4% and associated with BPD requiring postnatal steroids, IVH, severe IVH and cholestasis. Smaller head circumference percentile by gestation at discharge was also found. No association was found with ROP.
Conclusion
SIP is a complication of PDA medical treatment associated with high mortality and morbidities. Risk modeling based on 3 major risk factors can help inform the clinical decision on whether to proceed with treatment for these babies with PDA.