Co administration of antenatal steroids and indomethacin tied to intestinal perforation in preterm neonates

The study is published in the Journal of Pediatrics.

Hemasree Kandraju and colleagues from the Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada carried out this study 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' gestation or <750 g birth weight.

The researchers conducted a retrospective study of preterm infants admitted to Canadian Neonatal Network (CNN) units . Infants were classified into 2 groups based on receipt of antenatal steroids; the latter sub-grouped as recent (≤7 days before birth) or latent (>7 days before birth) exposures.

The co-exposure was PI. The primary outcome was SIP. Multivariable logistic regression analysis was used to calculate adjusted odds ratios (AOR).

The results of the study showed-

a. Among 4720 eligible infants, 4121 (87%) received ANS and 1045 (22.1%) received PI.

b. Among infants exposed to ANS, those who received PI had higher odds of SIP (AOR 1.61, 95% CI 1.14-2.28) compared with no PI.

c. Subgroup analyses revealed recent ANS exposure with PI had higher odds of SIP (AOR 1.67, 95% CI 1.15-2.43), but latent ANS exposure with PI did not (AOR 1.24, 95% CI 0.48-3.21), compared with the respective groups with no PI.

d. Among those not exposed to ANS, mortality was lower among those who received PI (AOR 0.45, 95% CI 0.28-0.73) compared with no PI.

Hence, the authors concluded that "in preterm neonates of <26 weeks' gestation or birth weight <750 g, co-exposure of ANS and PI was associated with SIP, especially if ANS was received within 7 days before birth. Among those unexposed to ANS, PI was associated with lower odds of mortality."