Abstract 1163
Poster Session I, Saturday, 5/1 (poster 72)
Background: Early IP (≤14 days of life) can occur with/without necrotizing enterocolitis (NEC) in LBW (≤1000 grams) neonates. Purpose: Determine factors associated with IP among LBW neonates enrolled in a randomized trial to assess efficacy of early DT. Methods: During a multicenter trial of DT (0.25 mg/kg×4, 0.125 mg/kg, 0.05 mg/kg) at 12-hour intervals and begun at 24-48 hours of life in ventilated neonates <1500 grams, comprehensive data was collected to assess neonatal morbidities and associated risk factors. Cases of early IP in LBW neonates: (1) had free air on an abdominal radiograph without other radiographic signs of NEC during the first 2 weeks of life and (2) required surgical intervention. Results: 18/186 (9.7%) of LBW neonates developed IP. 9 (50%) occurred ≤7 days of life. 12/18 cases of IP were localized without gross finding of NEC, four had gross finding of NEC, and two had abdominal drains placed without a laparotomy. Neonates with and without IP were similar with respect to antenatal steroids exposure, BW, GA, and SNAP score, prior to enrollment (p≥0.3). IP was not associated with indomethacin exposure (83% vs 64%, p=0.1). Factors associated with IP included FIO2 (.46±.04 vs .37±.01, p=0.03) and dopamine therapy ≥24 hours after study enrollment (89% vs 65%, p=0.04). Air leak (pneumothorax or PIE) during the first 5 days of life was also more common among neonates with IP or documented localized IP (8/18 vs 16/168, p<0.001 and 4/12 vs 19/172, p=0.02 respectively). Air leak was not associated with DT or dopamine therapy. When compared to placebo therapy, DT did not increase rate of IP or localized GP (12% vs 7%, p=0.3 and 8% vs 5%, p=0.5 respectively). However, DT was associated with an increased risk of very early (≤7 days) IP (8/92 vs 1/94, RR 8.2, CI 1.04 - 64, p=0.02). Five of eight very early IP in DT neonates were localized. Air leak was also more common among neonates with very early IP (4/9 vs 20/177, RR 5.4, CI 1.6-1.9, p=0.02). Conclusions: We conclude that early DT and pulmonary air leak or factors related to air leak increase risk of IP, especially during the first week of life in LBW neonates.
