Prophylactic Indomethacin and Intestinal Perforation in Extremely Low Birth Weight Infants
Prophylactic Indomethacin and Intestinal Perforation in Extremely Low Birth Weight Infants
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DOI：
10.1542/peds.2014-0183
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发表时间：
2014-11-01
期刊：
影响因子：
8
通讯作者：
Carlo, Waldemar A.
中科院分区：
文献类型：
--
作者：
Kelleher, John;Salas, Ariel A.;Carlo, Waldemar A.
目的：预防性使用吲哚美辛可减少严重脑室内出血，但可能会增加极低出生体重（ELBW）婴儿的自发性肠穿孔（SIP）。早期喂养可改善营养结果，但可能会增加 SIP 的风险。尽管有这些好处，但这些疗法的使用很大程度上取决于医生的偏好，部分原因是出于对 SIP 的担忧。 方法：这是一项对尤尼斯·肯尼迪·施赖弗国家儿童健康和人类发展新生儿研究网络研究所 1999 年至 2010 年的 15 751 名 ELBW 婴儿进行的队列研究，这些婴儿在出生后存活超过 12 小时。在未经调整的分析和针对中心和 SIP 风险进行调整的分析中，对接触和未接触预防性吲哚美辛和早期喂养的婴儿组之间的 SIP 风险进行了比较。 结果：在接触预防性吲哚美辛的婴儿中，与吲哚美辛/非早期喂养组相比，吲哚美辛/早期喂养组的 SIP 风险没有差异（调整后相对风险 [RR] 0.74， 95% 置信区间 [CI] 0.49-1.11）。与未服用吲哚美辛/未早期喂养组相比，服用吲哚美辛/早期喂养组的 SIP 风险较低（调整后 RR 0.58，95% CI 0.37-0.90，P = 0.0159）。在未接触吲哚美辛的婴儿中，与未早期喂养组相比，早期喂养与较低的 SIP 风险相关（调整后 RR 0.53，95% CI 0.36-0.777，P = 0.0011）。 结论：联合或单独使用预防性吲哚美辛和早期喂养与 ELBW 婴儿 SIP 风险增加无关。
OBJECTIVE: Prophylactic indomethacin reduces severe intraventricular hemorrhage but may increase spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants. Early feedings improve nutritional outcomes but may increase the risk of SIP. Despite their benefits, use of these therapies varies largely by physician preferences in part because of the concern for SIP.METHODS: This was a cohort study of 15 751 ELBW infants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 1999 to 2010 who survived beyond 12 hours after birth. The risk of SIP was compared between groups of infants with and without exposure to prophylactic indomethacin and early feeding in unadjusted analyses and in analyses adjusted for center and for risks of SIP.RESULTS: Among infants exposed to prophylactic indomethacin, the risk of SIP did not differ between the indomethacin/early-feeding group compared with the indomethacin/no-early-feeding group (adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.49-1.11). The risk of SIP was lower in the indomethacin/early-feeding group compared with the no indomethacin/no-early-feeding group (adjusted RR 0.58, 95% CI 0.37-0.90, P = .0159). Among infants not exposed to indomethacin, early feeding was associated with a lower risk of SIP compared with the no early feeding group (adjusted RR 0.53, 95% CI 0.36-0.777, P = .0011).CONCLUSIONS: The combined or individual use of prophylactic indomethacin and early feeding was not associated with an increased risk of SIP in ELBW infants.