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Growth Outcomes In Infants Undergoing Surgery For Spontaneous Intestinal Perforation

Annelies Mitchell1, Melanie Drewett1, 2, Nigel J Hall2, 3, Freya Pearson1, Mark Johnson1, 4

Institution(s)

1. Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton

2. Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, Southampton

3. University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton

4. NIHR Biomedical Research Centre Southampton, Southampton

Introduction (include hypothesis)

Spontaneous intestinal perforation (SIP), the cause of which is not well understood, is typically treated with surgery. The challenge of achieving satisfactory growth outcomes in infants undergoing abdominal surgery is well recognised. We hypothesised that infants having surgery for SIP would have poor nutrition and growth outcomes compared to preterm infants without SIP. We also investigated the association between these outcomes and type of surgery performed.

Methods (include source of funding and ethical approval if required)

Retrospective casenote review of all babies who underwent surgery in our unit for SIP between January 2009 and December 2014. Data was also collected on a comparator cohort consisting of all infants born at <30 weeks gestation and admitted to the neonatal unit and discharged home during the same 5 year period. We recorded demographic and clinical details, details of nutrition received following surgery and anthropometric outcomes including weight and weight standard deviation score (SDS). Differences between groups were assessed using students t-test (parametric data) or Wilcoxon signed rank test (non-parametric data, Stata IC v12.1).

Results

We identified 31 infants (68% male) who had surgery for SIP and 176 (52% male) in the comparator cohort. Infants in comparator and SIP groups demonstrated faltering growth between birth and discharge. This drop in weight SDS was greater in infants with SIP than in the comparator cohort (SIP 1.42 [SD1.39] vs. comparator 0.93 [SD0.09], p=0.014). Of 28 infants with SIP who survived to discharge, 18 (64%) were treated with resection and primary anastomosis and 10 (36%) with resection and stoma formation. Those who underwent primary anastomosis had greater gestational age and weight at birth, had a greater fall in weight SDS during stay, and spent less time on parenteral nutrition postoperatively compared to those who had a stoma formed.

Growth Outcomes In Infants Undergoing Surgery For Spontaneous Intestinal Perforation

Conclusions

SIP is associated with poor growth outcomes in preterm infants. Infants with SIP treated with primary anastomosis have greater growth faltering than those treated with a stoma and have fewer days on PN post-operatively. Further work is required to better understand these patterns of growth and their relation to nutrition and surgery, in order to optimise growth and other outcomes in this high-risk group of infants.

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