Stress-induced gastric findings in critically ill newborn infants : frequency and risk factors

• Published in: Intensive care medicine 2000-10, Vol.26 (10), p.1501-1506
• Main Authors: KUUSELA, A.-L, MÄKI, M, RUUSKA, T, LAIPPALA, P
• Format: Article
• Language: English
• Subjects: Adults; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Birth weight; Children; Critical Illness; Delivery, Obstetric - adverse effects; Delivery, Obstetric - methods; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Endoscopy; Gastroscopy; Gestational age; Hematemesis; Hemorrhage; Hospitals; Humans; Hypotension; Hypotension - complications; Infant, Newborn; Infants; Intensive care; Intensive care medicine; Intensive care units; Intensive Care Units, Neonatal; Intervention; Intubation; Lesions; Logistic Models; Medical sciences; Multivariate Analysis; Neonates; Newborn babies; Pediatrics; Peptic Ulcer Hemorrhage - diagnosis; Peptic Ulcer Hemorrhage - etiology; Peptic Ulcer Hemorrhage - prevention & control; Prospective Studies; Respiration, Artificial - adverse effects; Retrospective Studies; Risk Factors; Steroids; Stomach Ulcer - diagnosis; Stomach Ulcer - etiology; Stomach Ulcer - prevention & control; Stress, Psychological - complications; Stress, Psychological - prevention & control; Ventilation; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340051346

To evaluate whether infants treated in neonatal intensive care units have stress-induced bleeding from gastrointestinal tract or gastric lesions and to define risk factors for these findings. Part one: retrospective; part two: prospective. Tampere University Hospital, neonatal intensive care unit. In part one, 100 consecutive newborn infants treated in intensive care were retrospectively evaluated for gastrointestinal tract bleeding and risk factors, and in part two 89 gastroscopied and mechanically ventilated infants were prospectively evaluated for further risk factors for gastric mucosal lesions. The statistical evaluation of risk factors was made by multivariate analysis using logistic regression modeling. Of infants treated in the neonatal intensive care unit 20 % had signs of gastrointestinal bleeding. Mechanical ventilation was the only risk factor (OR = 4.06, 95 % confidence interval 1.21-12.3). In part two, when mechanically ventilated infants were prospectively evaluated, 53 % had remarkable gastric mucosal lesions. The analysis showed three other risk factors: abnormal and delayed delivery and hypotension after birth. Newborn infants treated in the intensive care unit had a high frequency of stress-induced gastric hemorrhage with gastric lesions similar to adults and children treated in intensive care. Mechanical ventilation is the main risk factor. Also mode of delivery and hypotension after birth increase the risk of stress-induced gastric lesions. These infants should be the target for prophylactic gastroprotective treatment.