Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation

Authors

Hemasree Kandraju, University of Toronto
Jaideep Kanungo, The University of British Columbia
Kyong Soon Lee, University of Toronto
Sibasis Daspal, University of Saskatchewan, College of Medicine
Mohammad Amin Adie, Windsor Regional Hospital
Jon Dorling, Dalhousie University, Faculty of Medicine
Xiang Y. Ye, Mount Sinai Hospital of University of Toronto
Shoo K. Lee, University of Toronto
Prakesh S. Shah, University of Toronto
Marc Beltempo
Joseph Ting
Zenon Cieslak
Rebecca Sherlock
Ayman Abou Mehrem
Jennifer Toye
Khalid Aziz
Carlos Fajardo
Jaya Bodani
Lannae Strueby
Mary Seshia
Deepak Louis
Ruben Alvaro
Amit Mukerji
Orlando Da SilvaFollow
Eugene Ng
Brigitte Lemyre
Thierry Daboval
Faiza Khurshid
Ermelinda Pelausa

Document Type

Article

Publication Date

8-1-2021

Journal

Journal of Pediatrics

Volume

235

First Page

34

Last Page

41.e1

URL with Digital Object Identifier

10.1016/j.jpeds.2021.03.012

Abstract

Objective: To evaluate the association of a combined exposure to antenatal steroids and prophylactic indomethacin with the outcome of spontaneous intestinal perforation (SIP) among neonates born at <26 weeks of gestation or <750 g birth weight. Study design: We conducted a retrospective study of preterm infants admitted to Canadian Neonatal Network units between 2010 and 2018. Infants were classified into 2 groups based on receipt of antenatal steroids; the latter subgrouped as recent (≤7 days before birth) or latent (>7 days before birth) exposures. The co-exposure was prophylactic indomethacin. The primary outcome was SIP. Multivariable logistic regression analysis was used to calculate aORs. Results: Among 4720 eligible infants, 4121 (87%) received antenatal steroids and 1045 (22.1%) received prophylactic indomethacin. Among infants exposed to antenatal steroids, those who received prophylactic indomethacin had higher odds of SIP (aOR 1.61, 95% CI 1.14-2.28) compared with no prophylactic indomethacin. Subgroup analyses revealed recent antenatal steroids exposure with prophylactic indomethacin had higher odds of SIP (aOR 1.67, 95% CI 1.15-2.43), but latent antenatal steroids exposure with prophylactic indomethacin did not (aOR 1.24, 95% CI 0.48-3.21), compared with the respective groups with no prophylactic indomethacin. Among those not exposed to antenatal steroids, mortality was lower among those who received prophylactic indomethacin (aOR 0.45, 95% CI 0.28-0.73) compared with no prophylactic indomethacin. Conclusions: In preterm neonates of <26 weeks of gestation or birth weight <750 g, co-exposure of antenatal steroids and prophylactic indomethacin was associated with SIP, especially if antenatal steroids was received within 7 days before birth. Among those unexposed to antenatal steroids, prophylactic indomethacin was associated with lower odds of mortality.