Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia
Objective To compare risk factors, surgical management, nutritional outcomes and short-term neonatal morbidity and mortality between preterm infants diagnosed with spontaneous intestinal perforation (SIP) and necrotising enterocolitis (NEC).Design Retrospective cohort study.Setting Level III neonata...
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BMJ Publishing Group
2025-07-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/9/1/e003667.full |
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| author | Kamal Ali Abdulaziz Homedi Mohanned Alrahili Mohammed Almahdi Abdulrahman Almehaid Saif Alsaif Lina Alsherbini Saud Aljadaan Omar Abbas Norah S Alsabti Ghiada A Almutairi Sarah F Almujarri Ashwag Alsubaie Mashael Almutairi Ahmed Alwatban |
| author_facet | Kamal Ali Abdulaziz Homedi Mohanned Alrahili Mohammed Almahdi Abdulrahman Almehaid Saif Alsaif Lina Alsherbini Saud Aljadaan Omar Abbas Norah S Alsabti Ghiada A Almutairi Sarah F Almujarri Ashwag Alsubaie Mashael Almutairi Ahmed Alwatban |
| author_sort | Kamal Ali |
| collection | DOAJ |
| description | Objective To compare risk factors, surgical management, nutritional outcomes and short-term neonatal morbidity and mortality between preterm infants diagnosed with spontaneous intestinal perforation (SIP) and necrotising enterocolitis (NEC).Design Retrospective cohort study.Setting Level III neonatal intensive care unit at a tertiary centre in Riyadh, Saudi Arabia.Patients Preterm infants born at <32 weeks’ gestation diagnosed with either SIP (n=42) or NEC (n=60) between January 2016 and December 2024.Main outcome measures Clinical characteristics, surgical intervention, nutritional outcomes, major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent predictors of mortality and prolonged parenteral nutrition (PN >60 days).Results Infants with SIP were diagnosed earlier (median 7 vs 20 days; p<0.001), had lower gestational age and birth weight and more often received postnatal hydrocortisone. Peritoneal drainage was the predominant surgical approach in SIP (98% vs 45%, p<0.001), whereas infants with NEC underwent more laparotomies (67% vs 5%) and stoma formation (42% vs 0%; both p<0.001). Infants with NEC had longer PN duration (48 vs 41 days, p=0.003), higher incidence of PN >60 days (46% vs 24%, p=0.028) and more PN-associated cholestasis (60% vs 36%, p=0.013). Growth failure at discharge was common (NEC 81%, SIP 73%). Major IVH was more frequent in SIP (41% vs 17%, p=0.007), while ROP needing therapy was more common in NEC (75% vs 52%, p=0.016). Independent predictors of mortality included sepsis (Adjusted OR (aOR) 10.5, 95% CI 2.67 to 41.22) and lower gestational age (aOR 1.35, 95% CI 1.04 to 1.77). NEC diagnosis predicted prolonged PN (aOR 0.20 for SIP vs NEC, 95% CI 0.07 to 0.58).Conclusions SIP and NEC differ significantly in timing of onset, surgical approach and nutritional trajectory. NEC is associated with greater surgical complexity and nutritional morbidity. These findings support the development of condition-specific surgical and feeding protocols. |
| format | Article |
| id | doaj-art-d8effca21c7049169d9d867b8178cf2b |
| institution | Kabale University |
| issn | 2399-9772 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj-art-d8effca21c7049169d9d867b8178cf2b2025-08-20T03:50:12ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722025-07-019110.1136/bmjpo-2025-003667Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi ArabiaKamal Ali0Abdulaziz Homedi1Mohanned Alrahili2Mohammed Almahdi3Abdulrahman Almehaid4Saif Alsaif5Lina Alsherbini6Saud Aljadaan7Omar Abbas8Norah S Alsabti9Ghiada A Almutairi10Sarah F Almujarri11Ashwag Alsubaie12Mashael Almutairi13Ahmed Alwatban141Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King`s College London, London, UKPediatrics, Western University, London, Ontario, CanadaCollage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaKing Abdullah International Medical Research Center, Riyadh, 11481, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaNeonatal Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaObjective To compare risk factors, surgical management, nutritional outcomes and short-term neonatal morbidity and mortality between preterm infants diagnosed with spontaneous intestinal perforation (SIP) and necrotising enterocolitis (NEC).Design Retrospective cohort study.Setting Level III neonatal intensive care unit at a tertiary centre in Riyadh, Saudi Arabia.Patients Preterm infants born at <32 weeks’ gestation diagnosed with either SIP (n=42) or NEC (n=60) between January 2016 and December 2024.Main outcome measures Clinical characteristics, surgical intervention, nutritional outcomes, major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent predictors of mortality and prolonged parenteral nutrition (PN >60 days).Results Infants with SIP were diagnosed earlier (median 7 vs 20 days; p<0.001), had lower gestational age and birth weight and more often received postnatal hydrocortisone. Peritoneal drainage was the predominant surgical approach in SIP (98% vs 45%, p<0.001), whereas infants with NEC underwent more laparotomies (67% vs 5%) and stoma formation (42% vs 0%; both p<0.001). Infants with NEC had longer PN duration (48 vs 41 days, p=0.003), higher incidence of PN >60 days (46% vs 24%, p=0.028) and more PN-associated cholestasis (60% vs 36%, p=0.013). Growth failure at discharge was common (NEC 81%, SIP 73%). Major IVH was more frequent in SIP (41% vs 17%, p=0.007), while ROP needing therapy was more common in NEC (75% vs 52%, p=0.016). Independent predictors of mortality included sepsis (Adjusted OR (aOR) 10.5, 95% CI 2.67 to 41.22) and lower gestational age (aOR 1.35, 95% CI 1.04 to 1.77). NEC diagnosis predicted prolonged PN (aOR 0.20 for SIP vs NEC, 95% CI 0.07 to 0.58).Conclusions SIP and NEC differ significantly in timing of onset, surgical approach and nutritional trajectory. NEC is associated with greater surgical complexity and nutritional morbidity. These findings support the development of condition-specific surgical and feeding protocols.https://bmjpaedsopen.bmj.com/content/9/1/e003667.full |
| spellingShingle | Kamal Ali Abdulaziz Homedi Mohanned Alrahili Mohammed Almahdi Abdulrahman Almehaid Saif Alsaif Lina Alsherbini Saud Aljadaan Omar Abbas Norah S Alsabti Ghiada A Almutairi Sarah F Almujarri Ashwag Alsubaie Mashael Almutairi Ahmed Alwatban Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia BMJ Paediatrics Open |
| title | Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia |
| title_full | Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia |
| title_fullStr | Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia |
| title_full_unstemmed | Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia |
| title_short | Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia |
| title_sort | comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants a retrospective cohort study from saudi arabia |
| url | https://bmjpaedsopen.bmj.com/content/9/1/e003667.full |
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