Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation: A prospective 5-year multicenter analysis

Jeremy G. Fisher, Brian A Jones, Ivan M. Gutierrez, Melissa A. Hull, Kuang Horng Kang, Michael Kenny, David Zurakowski, Biren P. Modi, Jeffrey D. Horbar, Tom Jaksic

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background Spontaneous intestinal perforation (SIP) has been recognized as a distinct disease entity. This study sought to quantify mortality associated with laparotomy-confirmed SIP and to compare it to mortality of laparotomy-confirmed necrotizing enterocolitis (NEC). Methods Data were prospectively collected on 177,618 very-low-birth-weight (VLBW, 401-1500 g) neonates born between January 2006 and December 2010 admitted to US hospitals participating in the Vermont Oxford Network (VON). SIP was defined at laparotomy as a focal perforation of the intestine without features suggestive of NEC or other intestinal abnormalities. The primary outcome was in-hospital mortality. Results At laparotomy, 2036 (1.1%) neonates were diagnosed with SIP and 4076 (2.3%) with NEC. Neonates with laparotomy-confirmed SIP had higher mortality (19%) than infants without NEC or SIP (5%, P = 0.003). However, laparotomy-confirmed SIP patients had significantly lower mortality than those with confirmed NEC (38%, P < 0.0001). Mortality in both NEC and SIP groups decreased with increasing birth weight and mortality was significantly higher for NEC than SIP in each birth weight category. Indomethacin and steroid exposure were more frequent in the SIP cohort than the other two groups (P < 0.001). Conclusions In VLBW infants, the presence of laparotomy-confirmed SIP increases mortality significantly. However, laparotomy-confirmed NEC mortality was double that of SIP. This relationship is evident regardless of birth weight. The variant mortality of laparotomy-confirmed SIP versus laparotomy-confirmed NEC highlights the importance of differentiating between these two diseases both for clinical and research purposes.

Original languageEnglish (US)
Pages (from-to)1215-1219
Number of pages5
JournalJournal of pediatric surgery
Volume49
Issue number8
DOIs
StatePublished - Jan 1 2014

Fingerprint

Intestinal Perforation
Laparotomy
Necrotizing Enterocolitis
Mortality
Birth Weight
Newborn Infant
Spontaneous Perforation
Very Low Birth Weight Infant
Infant Mortality
Hospital Mortality
Indomethacin
Intestines

Keywords

  • Birth weight category
  • Focal intestinal perforation
  • Low birth weight
  • Necrotizing enterocolitis
  • Neonatal mortality
  • Spontaneous intestinal perforation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation : A prospective 5-year multicenter analysis. / Fisher, Jeremy G.; Jones, Brian A; Gutierrez, Ivan M.; Hull, Melissa A.; Kang, Kuang Horng; Kenny, Michael; Zurakowski, David; Modi, Biren P.; Horbar, Jeffrey D.; Jaksic, Tom.

In: Journal of pediatric surgery, Vol. 49, No. 8, 01.01.2014, p. 1215-1219.

Research output: Contribution to journalArticle

Fisher, JG, Jones, BA, Gutierrez, IM, Hull, MA, Kang, KH, Kenny, M, Zurakowski, D, Modi, BP, Horbar, JD & Jaksic, T 2014, 'Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation: A prospective 5-year multicenter analysis', Journal of pediatric surgery, vol. 49, no. 8, pp. 1215-1219. https://doi.org/10.1016/j.jpedsurg.2013.11.051
Fisher, Jeremy G. ; Jones, Brian A ; Gutierrez, Ivan M. ; Hull, Melissa A. ; Kang, Kuang Horng ; Kenny, Michael ; Zurakowski, David ; Modi, Biren P. ; Horbar, Jeffrey D. ; Jaksic, Tom. / Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation : A prospective 5-year multicenter analysis. In: Journal of pediatric surgery. 2014 ; Vol. 49, No. 8. pp. 1215-1219.
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abstract = "Background Spontaneous intestinal perforation (SIP) has been recognized as a distinct disease entity. This study sought to quantify mortality associated with laparotomy-confirmed SIP and to compare it to mortality of laparotomy-confirmed necrotizing enterocolitis (NEC). Methods Data were prospectively collected on 177,618 very-low-birth-weight (VLBW, 401-1500 g) neonates born between January 2006 and December 2010 admitted to US hospitals participating in the Vermont Oxford Network (VON). SIP was defined at laparotomy as a focal perforation of the intestine without features suggestive of NEC or other intestinal abnormalities. The primary outcome was in-hospital mortality. Results At laparotomy, 2036 (1.1{\%}) neonates were diagnosed with SIP and 4076 (2.3{\%}) with NEC. Neonates with laparotomy-confirmed SIP had higher mortality (19{\%}) than infants without NEC or SIP (5{\%}, P = 0.003). However, laparotomy-confirmed SIP patients had significantly lower mortality than those with confirmed NEC (38{\%}, P < 0.0001). Mortality in both NEC and SIP groups decreased with increasing birth weight and mortality was significantly higher for NEC than SIP in each birth weight category. Indomethacin and steroid exposure were more frequent in the SIP cohort than the other two groups (P < 0.001). Conclusions In VLBW infants, the presence of laparotomy-confirmed SIP increases mortality significantly. However, laparotomy-confirmed NEC mortality was double that of SIP. This relationship is evident regardless of birth weight. The variant mortality of laparotomy-confirmed SIP versus laparotomy-confirmed NEC highlights the importance of differentiating between these two diseases both for clinical and research purposes.",
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T1 - Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation

T2 - A prospective 5-year multicenter analysis

AU - Fisher, Jeremy G.

AU - Jones, Brian A

AU - Gutierrez, Ivan M.

AU - Hull, Melissa A.

AU - Kang, Kuang Horng

AU - Kenny, Michael

AU - Zurakowski, David

AU - Modi, Biren P.

AU - Horbar, Jeffrey D.

AU - Jaksic, Tom

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background Spontaneous intestinal perforation (SIP) has been recognized as a distinct disease entity. This study sought to quantify mortality associated with laparotomy-confirmed SIP and to compare it to mortality of laparotomy-confirmed necrotizing enterocolitis (NEC). Methods Data were prospectively collected on 177,618 very-low-birth-weight (VLBW, 401-1500 g) neonates born between January 2006 and December 2010 admitted to US hospitals participating in the Vermont Oxford Network (VON). SIP was defined at laparotomy as a focal perforation of the intestine without features suggestive of NEC or other intestinal abnormalities. The primary outcome was in-hospital mortality. Results At laparotomy, 2036 (1.1%) neonates were diagnosed with SIP and 4076 (2.3%) with NEC. Neonates with laparotomy-confirmed SIP had higher mortality (19%) than infants without NEC or SIP (5%, P = 0.003). However, laparotomy-confirmed SIP patients had significantly lower mortality than those with confirmed NEC (38%, P < 0.0001). Mortality in both NEC and SIP groups decreased with increasing birth weight and mortality was significantly higher for NEC than SIP in each birth weight category. Indomethacin and steroid exposure were more frequent in the SIP cohort than the other two groups (P < 0.001). Conclusions In VLBW infants, the presence of laparotomy-confirmed SIP increases mortality significantly. However, laparotomy-confirmed NEC mortality was double that of SIP. This relationship is evident regardless of birth weight. The variant mortality of laparotomy-confirmed SIP versus laparotomy-confirmed NEC highlights the importance of differentiating between these two diseases both for clinical and research purposes.

AB - Background Spontaneous intestinal perforation (SIP) has been recognized as a distinct disease entity. This study sought to quantify mortality associated with laparotomy-confirmed SIP and to compare it to mortality of laparotomy-confirmed necrotizing enterocolitis (NEC). Methods Data were prospectively collected on 177,618 very-low-birth-weight (VLBW, 401-1500 g) neonates born between January 2006 and December 2010 admitted to US hospitals participating in the Vermont Oxford Network (VON). SIP was defined at laparotomy as a focal perforation of the intestine without features suggestive of NEC or other intestinal abnormalities. The primary outcome was in-hospital mortality. Results At laparotomy, 2036 (1.1%) neonates were diagnosed with SIP and 4076 (2.3%) with NEC. Neonates with laparotomy-confirmed SIP had higher mortality (19%) than infants without NEC or SIP (5%, P = 0.003). However, laparotomy-confirmed SIP patients had significantly lower mortality than those with confirmed NEC (38%, P < 0.0001). Mortality in both NEC and SIP groups decreased with increasing birth weight and mortality was significantly higher for NEC than SIP in each birth weight category. Indomethacin and steroid exposure were more frequent in the SIP cohort than the other two groups (P < 0.001). Conclusions In VLBW infants, the presence of laparotomy-confirmed SIP increases mortality significantly. However, laparotomy-confirmed NEC mortality was double that of SIP. This relationship is evident regardless of birth weight. The variant mortality of laparotomy-confirmed SIP versus laparotomy-confirmed NEC highlights the importance of differentiating between these two diseases both for clinical and research purposes.

KW - Birth weight category

KW - Focal intestinal perforation

KW - Low birth weight

KW - Necrotizing enterocolitis

KW - Neonatal mortality

KW - Spontaneous intestinal perforation

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