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Focal Small Bowel Perforation
Meta-Analysis Evaluating the Risk of Focal Small Bowel Perforation (FSBP) Following Early Postnatal Dexamethasone (EPD) Administration in Extremely Low Birth Weight (ELBW) Infants. Gordon PV, and Marshall DD. J Perinatol 2000;20:461.
This study conducted a systematic review and applied the techniques of meta-analysis to summarize the results of existing studies to test the hypothesis that EDP is associated with an increased risk of FSBP in ELBW infants. Studies were included if they were randomized placebo-controlled trials, at least 95% of study infants had birth weights < 1000 grams, dexamethasone or placebo was administered within 48 hours of age, and FSBP was reported as an outcome variable. From the pooled sample of 1386 infants, EDP administration was significantly associated with FSBP (odds ratio 2.01, 95% CI 1.29-3.13; p=0.003). If 2 additional studies with a zero incidence of FSBP were included in the analysis, the pooled sample of 1518 infants also demonstrated a significant association between EDP and FSBP (odds ratio 1.98, 95% CI 1.28-3.07; p=0.002).
Comment. FSBP as a complication of EDP was reported earlier this year by this same author in a paper published in J Perinatol, and reviewed in Vol 1, Issue 1 of FSN Journal Club. The current study combines that data with a meta-analysis of 5 other studies of EDP, and clearly demonstrates that ELBW infants who receive EDP have about twice the risk of this complication compared to those who don’t receive EDP. It is unclear why ELBW infants are more susceptible to FSBP after EDP during the first week of life. Perhaps the frequent presence of umbilical artery catheters during the first week of life may be a contributory factor. In any case, it seems that we would be wise to reserve dexamethasone prophylaxis for those ELBW infants who remain ventilator dependent at 2-3 weeks of age.
Andrew B. Kairalla MD