Al. Kuusela et al., Stress-induced gastric findings in critically ill newborn infants: frequency and risk factors, INTEN CAR M, 26(10), 2000, pp. 1501-1506
Objective: To evaluate whether infants treated in neonatal intensive care u
nits have stress-induced bleeding from gastrointestinal tract or gastric le
sions and to define risk factors for these findings. Design: Part one: retr
ospective; part two: prospective. Setting: Tampere University Hospital, neo
natal intensive care unit. Patients and interventions: In part one, 100 con
secutive newborn infants treated in intensive care were retrospectively eva
luated for gastrointestinal tract bleeding and risk factors, and in part tw
o 89 gastroscopied and mechanically ventilated infants were prospectively e
valuated for further risk factors for gastric mucosal lesions. The statisti
cal evaluation of risk factors was made by multivariate analysis using logi
stic regression modeling. Main results: 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 prospect
ively evaluated, 53 % had remarkable gastric mucosal lesions. The analysis
showed three other risk factors: abnormal and delayed delivery and hypotens
ion after birth. Conclusions: Newborn infants treated in the intensive care
unit had a high frequency of stress-induced gastric hemorrhage with gastri
c lesions similar to adults and children treated in intensive care. Mechani
cal ventilation is the main risk factor. Also mode of delivery and hypotens
ion after birth increase the risk of stress-induced gastric lesions. These
infants should be the target for prophylactic gastroprotective treatment.