Risk Factors and Epidemiology of Spontaneous Intestinal Perforation among Infants Born at 22–24 Weeks’ Gestational Age

Objective To describe the epidemiology, risk factors, and timing of spontaneous intestinal perforation (SIP) among infants born at 22–24 weeks’ gestational age (GA). Study design Observational cohort study among infants born at 22–24 weeks’ GA in 446 neonatal intensive care units. Results We identified 9712 infants, of whom 379 (3.9%) developed SIP. SIP incidence increased with decreasing GA ( P < 0.001). Antenatal magnesium (odds ratio (OR) 1.42; 95% confidence interval (CI), 1.09–1.85), antenatal indomethacin (OR 1.40; 95% CI, 1.06–1.85), postnatal indomethacin (OR 1.61; 95% CI, 1.23–2.11), and postnatal hydrocortisone exposure (OR 2.02; 95% CI 1.50–2.73) were associated with SIP. Infants who lost 15–20% (OR 1.77; 95% CI, 1.28–2.44) or >20% (OR 2.04; 95% CI, 1.46–2.85) of birth weight had higher odds of SIP than infants with weight loss <10%. Conclusions Antenatal magnesium exposure, antenatal indomethacin exposure, postnatal hydrocortisone exposure, postnatal indomethacin exposure, and weight loss ≥15% were associated with SIP.