Published online November 12, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1458-e1464 (doi:10.1542/peds.2006-2804)
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ARTICLE

Maternal Factors in Extremely Low Birth Weight Infants Who Develop Spontaneous Intestinal Perforation

Corinne J. Ragouilliaux, MDa, Susan E. Keeney, MDa, Hal K. Hawkins, MDb and Judith L. Rowen, MDc

a Neonatology Division
c Infectious Diseases and Immunology Division, Department of Pediatrics
b Department of Pathology, University of Texas Medical Branch, Galveston, Texas

BACKGROUND. Spontaneous intestinal perforation of the extremely low birth weight infant (≤1000 g) is associated with a high incidence of Candida and coagulase-negative Staphylococcus sepsis. Little is known about prenatal risk factors, and histopathologic examination of placentas in infants with spontaneous intestinal perforation has not been reported.

OBJECTIVES. Our objective was to investigate maternal factors and specific placental findings in a sample of infants with spontaneous intestinal perforation. We compared the maternal factors and clinical outcomes to a matched control group.

PATIENTS AND METHODS. This single-center, retrospective cohort study was conducted between January 2001 and December 2005. The records of extremely low birth weight infants with spontaneous intestinal perforation were reviewed (n = 16). Study infants were matched to 2 infants in the control group; any twin of a study patient was also included as a control subject (n = 35). Histopathologic examination of placentas included standard hematoxylin and eosin and methenamine silver stains.

RESULTS. Infants with spontaneous intestinal perforation were more likely than control subjects to have severe placental chorioamnionitis with fetal vascular response (40% vs 12%); 2 placentas also tested positive for yeast versus none in the control subjects. Mothers of infants with spontaneous intestinal perforation were more likely than control subjects to have received antibiotics before or at delivery (93% vs 57%). Fifty percent of the infants had Candida, and 31% in the spontaneous intestinal perforation group had coagulase-negative Staphylococcus sepsis versus 6% in the control subjects. Finally, infants with spontaneous intestinal perforation had delayed enteral feeding (64 ± 30 vs 31 ± 10 days) and prolonged hospitalization (155 ± 48 vs 108 ± 36 days).

CONCLUSIONS. Spontaneous intestinal perforation in the extremely low birth weight infant is a neonatal disease related to placental inflammation. We alert practitioners to the importance of placental findings, because they may be positive for yeast.

Key Words: chorioamnionitis • funisitis • candidiasis • coagulase-negative Staphylococcus • neonate

Abbreviations: SIP—spontaneous intestinal perforation • ELBW—extremely low birth weight • NEC—necrotizing enterocolitis • CONS—coagulase-negative Staphylococcus

Accepted May 14, 2007.