PEDIATRICS Vol. 76 No. 3 September 1985, pp. 406-410
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Increased Risk of Gastrointestinal Perforations in Neonates Mechanically Ventilated with Either Face Mask or Nasal Prongs

Jeffery S. Garland MD1, David B. Nelson MD, MSc1, Thomas Rice MD1, and Josef Neu MD1

1 From the Medical College of Wisconsin, Department of Pediatrics, Milwaukee Children's Hospital, Milwaukee

Twenty cases of gastrointestinal perforations not associated with necrotizing enterocolitis or a bowel obstruction (GPNN) were reviewed. Fifteen infants suffered perforations during cycle ventilation. Perforations were localized in the stomach, duodenum, ileum, and jejunum. To determine if the type of mechanical ventilation used (ie, face mask, nasal prongs, or endotracheal tube) was associated with GPNN, a matched case-control analysis was performed. Case and control infants were matched by means of Apgar scores, gestational age, and length of time on ventilatory support. The Mantel-Haenszel estimate for estimating odds-ratios was used to determine that infants ventilated with nasal prongs or face mask were more likely to develop a gastrointestinal perforation than control infants ventilated with endotracheal tubes (odds-ratio ge29.6). This risk was associated with both upper gastrointestinal perforations (odds-ratio ge21.0) and lower gastrointestinal perforations (odds-ratio ge15.3). Routine use of mechanical ventilation with either nasal prongs or face mask appears to be associated with an unacceptable risk of gastrointestinal perforations in sick neonates.

Key Words: gastrointestional perforations • mechanical ventilation • face mask • nasal prongs • neonates

Accepted on December 3, 1984




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