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Initial surgery for spontaneous intestinal perforation in extremely low birth weight infants is not associated with mortality or in-hospital morbidities

Journal of Perinatology volume 44, pages 1746–1754 (2024)Cite this article

Subjects

Abstract

Objective

Determine short-term outcomes following peritoneal drain (PD), laparotomy (LAP) after PD (PD-LAP), and LAP in extremely low birth weight (ELBW) infants with spontaneous intestinal perforation (SIP).

Study design

ELBW infants with SIP were identified using the Children’s Hospitals Neonatal Database. Mortality and length of stay (LOS) were compared among groups.

Results

Of 729 SIP infants from 6/2010-12/2016, 383(53%) received PD, 61(8%) PD-LAP, and 285(39%) LAP. PD infants had lower GA at birth, at SIP diagnosis and upon admission than PD-LAP or LAP; and higher sepsis rates than LAP. Bivariate analysis and Kaplan-Meier survival estimates suggested PD had increased mortality vs. PD-LAP and LAP (27%, 11.5%, and 15.8% respectively, p < 0.001). However, surgical approach was not significantly associated with mortality in multivariable analysis accounting for GA and illness severity. LOS did not differ by surgical approach.

Conclusions

In ELBW infants with SIP, mortality, and LOS are independent of the initial surgical approach.

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Fig. 1
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Fig. 4: Variability in hospital length of stay in infants <1000 grams birth weight with spontaneous intestinal perforation across CHND centers.

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Data availability

All data relevant to the study is included in the article. Requests for additional material can be made to Amy Hair at abhair@bcm.edu.

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Acknowledgements

Data for use in this study were supplied by Children’s Hospitals Neonatal Consortium, Inc. (CHNC). Any analysis, interpretation, or conclusion based on these data is solely that of the authors, and CHNC specifically disclaims responsibility for any such analysis, interpretation, or conclusion. We’d like to acknowledge additional members of the CHND Surgical NEC Focus Group, not otherwise listed as a contributing author, who participated in part in this project, including Michael Padula, Allison Rose, Lynn Fuchs, Carla Snider, Kera McNelis, Hala Chaaban, Hannah Hightower, Bonny Jasani and Catherine Hunter. We’d also like to thank the CHNC leadership and executive committee without whom this work would not have been possible: Jeanette Asselin (ex officio), David Durand (ex officio), Francine Dykes (ex officio), Karna Murthy (Chair), Michael Padula, Eugenia Pallotto, Theresa Grover, Beverly Brozanski, and Anthony Piazza, Kristina Reber, Joanne Lagatta, Joan Smith, Lamia Soghier, Billie Short, and Jacquelyn Evans are members of the Children’s Hospitals Neonatal Consortium, Inc. For more information, please contact: support@thechnc.org. Finally, we are indebted to the following institutions that serve infants and their families, and these institutions also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND). The site sponsors/contributors for the CHND are also included: 1. Children’s Healthcare of Atlanta Egleston, Atlanta, GA (Anthony Piazza). 2. Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA (Gregory Sysyn). 3. Dell Children’s Hospital, Austin, TX (Ashley Lucke, Molly Pont). 4. Children’s Hospital of Alabama, Birmingham, AL (Carl Coghill, Allison Black). 5. Children’s Hospital Boston, Boston, MA (Anne Hansen). 6. Levine Children’s Hospital, Charlotte, NC (Eugenia Pallotto). 7. Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL (Gustave Falciglia). 8. Cincinnati Children’s Hospital, Cincinnati, OH (Beth Haberman). 9. Cleveland Clinic Children’s Hospital, Cleveland, OH (Hany Aly, Tetyana Nesterenko). 10. Nationwide Children’s Hospital, Columbus, OH (Thomas Bartman). 11. Children’s Health Center, Dallas, TX (Lina Chalak, Sushmita Yallapragada). 12. Children’s Hospital Colorado, Denver, CO (Danielle Smith, Stephanie Bourque). 13. Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan). 14. Cook Children’s Health Care System, Fort Worth, TX (Annie Chi). 15. Connecticut Children’s Hospital, Hartford, CT (Annmarie Golioto). 16. Texas Children’s Hospital, Houston, TX (Kristina Reber). 17. Riley Children’s Hospital, Indianapolis, IN (Rebecca Rose). 18. University of Iowa Children’s Hospital, Iowa City, IA (Julie Lindower). 19. Children’s Mercy Hospitals and Clinics, Kansas City, MO (Julie Weiner). 20. Arkansas Children’s Hospital, Little Rock, AR (Laura Carroll). 21. Children’s Hospital Los Angeles, Los Angeles, CA (Rachel Chapman). 22. American Family Children’s Hospital, Madison, WI (Nina Menda). 23. Le Bonheur Children’s Hospital, Memphis, TN (Mark Weems). 24. Children’s Hospital Wisconsin, Milwaukee, WI (Joanne Lagatta). 25. Children’s Hospital of Minnesota, Minneapolis, MN, (Ann Downey). 26. UCSF Benioff Children’s Hospital, Oakland, CA (Priscilla Joe). 27. Oklahoma Children’s Hospital, Oklahoma City, OK (Patricia Williams, Trent Tipple). 28. Omaha Children’s Hospital, Omaha, NE (Nicole Birge). 29. Children’s Hospital of Orange County, Orange, CA (Michel Mikhael). 27. Advent Health for Children, Orlando, FL (Narendra Dereddy, Rajan Wadhawan). 28. Nemours Children’s Hospital, Orlando, FL (Aaron Weiss). 29. The Children’s Hospital of Philadelphia, Philadelphia, PA (Michael Padula). 30. St. Christopher’s Hospital for Children, Philadelphia, PA (Vilmaris Quinones). 31. Phoenix Children’s Hospital, Phoenix, AZ (Pam Griffiths). 32. Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Toby Yanowitz). 33. Mayo Eugenia Litta Children’s Hospital, Rochester, MN (Ellen Bendel-Stenzel). 34. Primary Children’s Hospital, Salt Lake City, UT (Con Yee Ling). 35. Rady Children’s Hospital, San Diego, CA (Mark Speziale). 36. Seattle Children’s Hospital, Seattle, WA (Elizabeth Jacobson, Robert DiGeronimo). 37. St. Louis Children’s Hospital, St Louis, MO (Beverly Brozanski, Rakesh Rao). 38. All Children’s Hospital, St. Petersburg, FL (Linda Van Marter). 39. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee). 40. Children’s National Medical Center, Washington, DC (Billie Short). 41. Nemours Children’s Hospital, Wilmington, DE (Kevin Sullivan). 42. Brenner Children’s Hospital, Winston-Salem, NC (Cherrie Welch).

Author information

Author notes

  1. A list of members and their affiliations appears in the Supplementary Information.

Authors and Affiliations

  1. Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Amy B. Hair, Muralidhar H. Premkumar & Kristina Reber

  2. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Kevin M. Sullivan

  3. Nemours Children’s Hospital, Wilmington, DE, USA

    Kevin M. Sullivan

  4. Children’s Hospital of Orange County, Orange, CA, USA

    Irfan Ahmad

  5. Children’s Hospitals Association, Lenexa, KS, USA

    Isabella Zaniletti

  6. University of Colorado, Children’s Hospital of Colorado, Aurora, CO, USA

    Shannon N. Acker

  7. Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA

    Katie A. Huff & Troy A. Markel

  8. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Sujir Pritha Nayak

  9. Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Robert DiGeronimo

  10. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Jae Kim

  11. Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Jessica Roberts & Anthony J. Piazza

  12. Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, USA

    Beverly Brozanski

  13. Missouri University of Missouri Kansas City School of Medicine, Children’s Mercy Hospital, Kansas City, MO, USA

    Jotishna Sharma

  14. University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Toby D. Yanowitz

Authors
  1. Amy B. Hair
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Consortia

Children’s Hospitals Neonatal Consortium Necrotizing Enterocolitis Focus Group

  • Amy B. Hair
  • , Kevin M. Sullivan
  • , Irfan Ahmad
  • , Isabella Zaniletti
  • , Shannon N. Acker
  • , Muralidhar H. Premkumar
  • , Kristina Reber
  • , Katie A. Huff
  • , Sujir Pritha Nayak
  • , Robert DiGeronimo
  • , Jae Kim
  • , Jessica Roberts
  • , Troy A. Markel
  • , Beverly Brozanski
  • , Jotishna Sharma
  • , Anthony J. Piazza
  •  & Toby D. Yanowitz

Contributions

ABH, KMS, IA, MP, and TY contributed to the conception and design of the study. All authors contributed to the data acquisition and provided critical input during the Children’s Hospitals Neonatal Consortium NEC focus group meetings. IZ conducted data analysis. ABH wrote the first draft of the manuscript. TY helped to critically draft and revise the manuscript. All authors helped revise the manuscript and have approved the final version.

Corresponding author

Correspondence to Amy B. Hair.

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Competing interests

The authors declare no competing interests.

Ethics

IRB approval was obtained at each participating site prior to entering data into CHND. For analysis of de-identified data, the Stanley Manne Research Center (2011-14673) reviewed and approved this work. The study was performed in accordance with the Declaration of Helsinki.

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Hair, A.B., Sullivan, K.M., Ahmad, I. et al. Initial surgery for spontaneous intestinal perforation in extremely low birth weight infants is not associated with mortality or in-hospital morbidities. J Perinatol 44, 1746–1754 (2024). https://doi.org/10.1038/s41372-024-02037-8

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