{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:33:22Z","timestamp":1785530002412,"version":"3.56.0"},"reference-count":36,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,12,1]]},"abstract":"<jats:p>BACKGROUND. Spontaneous intestinal perforation of the extremely low birth weight infant (\u22641000 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.<\/jats:p><jats:p>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.<\/jats:p><jats:p>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.<\/jats:p><jats:p>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 \u00b1 30 vs 31 \u00b1 10 days) and prolonged hospitalization (155 \u00b1 48 vs 108 \u00b1 36 days).<\/jats:p><jats:p>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.<\/jats:p>","DOI":"10.1542\/peds.2006-2804","type":"journal-article","created":{"date-parts":[[2007,11,13]],"date-time":"2007-11-13T02:05:47Z","timestamp":1194919547000},"page":"e1458-e1464","source":"Crossref","is-referenced-by-count":47,"title":["Maternal Factors in Extremely Low Birth Weight Infants Who Develop Spontaneous Intestinal Perforation"],"prefix":"10.1542","volume":"120","author":[{"given":"Corinne J.","family":"Ragouilliaux","sequence":"first","affiliation":[{"name":"Neonatology Division"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Keeney","sequence":"additional","affiliation":[{"name":"Neonatology Division"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hal K.","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith L.","family":"Rowen","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Immunology Division, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2007,12,1]]},"reference":[{"key":"2021120901580069000_R1","doi-asserted-by":"crossref","unstructured":"Aschner JL, Deluga KS, Metlay LA, Emmens RW, Hendricks-Munoz, KD. Spontaneous focal gastrointestinal perforation in very low birth weight infants. J Pediatr.\u20081988;113:364\u2013367","DOI":"10.1016\/S0022-3476(88)80285-3"},{"key":"2021120901580069000_R2","doi-asserted-by":"crossref","unstructured":"Meyer CL, Payne NR, Roback SA. Spontaneous, isolated intestinal perforations in neonates with birth weight &lt;1,000g, not associated with necrotizing enterocolitis. J Pediatr Surg.\u20081991;26:714\u2013717","DOI":"10.1016\/0022-3468(91)90017-N"},{"key":"2021120901580069000_R3","doi-asserted-by":"crossref","unstructured":"Mintz AC, Applebaum H. Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J Pediatr Surg.\u20081993;28:857\u2013860","DOI":"10.1016\/0022-3468(93)90345-L"},{"key":"2021120901580069000_R4","unstructured":"Novack CM, Waffarn F, Sills, JH, Pousti TJ, Warden MJ, Cunningham MD. Focal intestinal perforation in the extremely low birth weight infant. J Perinatol.\u20081994;14:450\u2013453"},{"key":"2021120901580069000_R5","doi-asserted-by":"crossref","unstructured":"Schmidt B, Davis P, Moddemann D, et al. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med.\u20082001;344:1966\u20131972","DOI":"10.1056\/NEJM200106283442602"},{"key":"2021120901580069000_R6","doi-asserted-by":"crossref","unstructured":"Adderson EE, Pappin A, Pavia AT. Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis J Pediatr Surg.\u20081998;33:1463\u20131467","DOI":"10.1016\/S0022-3468(98)90475-4"},{"key":"2021120901580069000_R7","doi-asserted-by":"crossref","unstructured":"Hwang H, Murphy JJ, Gow KW, Magee JF, Bekhit E, Jamieson D. Are localized intestinal perforations distinct from necrotizing enterocolitis?J Pediatr Surg.\u20082003;38:763\u2013767","DOI":"10.1016\/jpsu.2003.50162"},{"key":"2021120901580069000_R8","doi-asserted-by":"crossref","unstructured":"Okuyama H, Kubota A, Oue T, Kuroda S, Ikegami R, Kamiyama M. A comparison of the clinical presentation and outcome of focal intestinal perforation and necrotizing enterocolitis in very-low-birth-weight neonates. Pediatr Surg Int.\u20082002;18:704\u2013706","DOI":"10.1007\/s00383-002-0839-7"},{"key":"2021120901580069000_R9","doi-asserted-by":"crossref","unstructured":"Coates EW, Karlowicz MG, Croitoru DP, Buescher ES. Distinctive distribution of pathogens associated with peritonitis in neonates with focal intestinal perforation compared with necrotizing enterocolitis. Pediatrics.\u20082005;116(2). Available at: www.pediatrics.org\/cgi\/content\/full\/116\/2\/e241","DOI":"10.1542\/peds.2004-2537"},{"key":"2021120901580069000_R10","doi-asserted-by":"crossref","unstructured":"Tatekawa Y, Muraji T, Imai Y, Nishijima E, Tsugawa C. The mechanism of focal intestinal perforations in neonates with low birth weight. Pediatr Surg Int.\u20081999;15:549\u2013552","DOI":"10.1007\/s003830050668"},{"key":"2021120901580069000_R11","unstructured":"Dee-Go J, Ramanathan R, Durand M, Barton L, Go V, deLemos R. Spontaneous intestinal perforation in the extremely low birth weight infant: pathogenesis and diagnosis [abstract]. Pediatrics.\u20081997;100(suppl):503\u2013504"},{"key":"2021120901580069000_R12","doi-asserted-by":"crossref","unstructured":"Stark AR, Carlo WA, Tyson JE, et al. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. N Engl J Med.\u20082001;344:95\u2013101","DOI":"10.1056\/NEJM200101113440203"},{"key":"2021120901580069000_R13","doi-asserted-by":"crossref","unstructured":"Watterberg KL, Gerdes JS, Cole CH, et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics.\u20082004;114:1649\u20131657","DOI":"10.1542\/peds.2004-1159"},{"key":"2021120901580069000_R14","doi-asserted-by":"crossref","unstructured":"Attridge JT, Herman AC, Gurka MJ, Griffin MP, McGahren ED, Gordon PV. Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations. J Perinatol.\u20082006;26:49\u201354","DOI":"10.1038\/sj.jp.7211407"},{"key":"2021120901580069000_R15","doi-asserted-by":"crossref","unstructured":"Attridge JT, Clark R, Walker MW, Gordon PV. New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations. J Perinatol.\u20082006;26:185\u2013188","DOI":"10.1038\/sj.jp.7211439"},{"key":"2021120901580069000_R16","doi-asserted-by":"crossref","unstructured":"Lau J, Magee F, Qiu Z, Hoube J, Von Dadelszen P, Lee SK. Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only. Am J Obstet Gynecol.\u20082005;193:708\u2013713","DOI":"10.1016\/j.ajog.2005.01.017"},{"key":"2021120901580069000_R17","doi-asserted-by":"crossref","unstructured":"Redline RW, Heller D, Keating S, Kingdom J. Placental diagnostic criteria and clinical correlation-a workshop report. Placenta.\u20082005;26(suppl A):S114\u2013S117","DOI":"10.1016\/j.placenta.2005.02.009"},{"key":"2021120901580069000_R18","doi-asserted-by":"crossref","unstructured":"Lahra MM, Jeffery HE. A fetal response to chorioamnionitis is associated with early survival after preterm birth. Am J Obstet Gynecol.\u20082004;190:147\u2013151","DOI":"10.1016\/j.ajog.2003.07.012"},{"key":"2021120901580069000_R19","doi-asserted-by":"crossref","unstructured":"Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics.\u20081996;97:210\u2013215","DOI":"10.1542\/peds.97.2.210"},{"key":"2021120901580069000_R20","doi-asserted-by":"crossref","unstructured":"Romero R, Espinoza J, Gonc\u0327alves LF, Kusanovic JP, Friel LA, Nien JK. Inflammation in preterm and term labour and delivery. Semin Fetal Neonatal Med.\u20082006;11:317\u2013326","DOI":"10.1016\/j.siny.2006.05.001"},{"key":"2021120901580069000_R21","doi-asserted-by":"crossref","unstructured":"Goepfert AR, Andrews WW, Carlo W, et al. Umbilical cord plasma interleukin-6 concentrations in preterm infants and risk of neonatal morbidity. Am J Obstet Gynecol.\u20082004;191:1375\u20131381","DOI":"10.1016\/j.ajog.2004.06.086"},{"key":"2021120901580069000_R22","doi-asserted-by":"crossref","unstructured":"Rad R, Dossumbekova A, Neu B, et al. Cytokine gene polymorphisms influence mucosal cytokine expression, gastric inflammation, and host specific colonisation during Helicobacter pylori infection. Gut.\u20082004;53:1082\u20131089","DOI":"10.1136\/gut.2003.029736"},{"key":"2021120901580069000_R23","doi-asserted-by":"crossref","unstructured":"Whyte RK, Hussain Z, deSa D. Antenatal infections with Candida species. Arch Dis Child.\u20081982;57:528\u2013535","DOI":"10.1136\/adc.57.7.528"},{"key":"2021120901580069000_R24","unstructured":"Schwartz DA, Reef S. Candida albicans placentitis and funisitis: early diagnosis of congenital candidemia by histopathologic examination of umbilical cord vessels. Pediatr Infect Dis. J.\u20081990;9:661\u2013665"},{"key":"2021120901580069000_R25","doi-asserted-by":"crossref","unstructured":"Qureshi F, Jacques SM, Bendon RW, et al. Candida funisitis: a clinicopathologic study of 32 cases. Pediatr Devel Pathol.\u20081998;1:118\u2013124","DOI":"10.1007\/s100249900014"},{"key":"2021120901580069000_R26","doi-asserted-by":"crossref","unstructured":"Rivasi F, Gasser B, Bagni A, Ficarra G, Negro RM, Philippe E. Placental candidiasis: report of four cases, one with villitis. Acta Pathol Microbiol Immunol Scand.\u20081998;106:1165\u20131169","DOI":"10.1111\/j.1699-0463.1998.tb00273.x"},{"key":"2021120901580069000_R27","doi-asserted-by":"crossref","unstructured":"Scheifele DW, Bjornson GL, Dyer RA, Dimmick JE. Delta-like toxin produced by coagulase negative staphylococci is associated with neonatal necrotizing enterocolitis. Infect Immun.\u20081987;55:2268\u20132273","DOI":"10.1128\/iai.55.9.2268-2273.1987"},{"key":"2021120901580069000_R28","doi-asserted-by":"crossref","unstructured":"Luo CC, Shih HH, Chiu CH, Lin JN. Translocation of coagulase-negative bacterial staphylococci in rats following intestinal ischemia-reperfusion injury. Biol Neonate.\u20082004;85:151\u2013154","DOI":"10.1159\/000075065"},{"key":"2021120901580069000_R29","doi-asserted-by":"crossref","unstructured":"De Repentigny L, Aumont F, Bernard K, Belhumeur P. Characterization of binding of Candida albicans to small intestinal mucin and its role in adherence to mucosal epithelial cells. Infect Immun.\u20082000;68:3172\u20133179","DOI":"10.1128\/IAI.68.6.3172-3179.2000"},{"key":"2021120901580069000_R30","unstructured":"Gianotti L, Alexander JW, Fukushima R, Childress CP. Translocation of Candida albicans is related to the blood flow of individual intestinal villi. Circ Shock.\u20081993;40:250\u2013257"},{"key":"2021120901580069000_R31","doi-asserted-by":"crossref","unstructured":"Nucci M, Anaissie E. Revisiting the source of candidemia: skin or gut?Clin Infect Dis.\u20082001;33:1959\u20131967","DOI":"10.1086\/323759"},{"key":"2021120901580069000_R32","doi-asserted-by":"crossref","unstructured":"Kao AS, Brandt ME, Pruitt WR, et al. The epidemiology of candidemia in two United States cities: results of a population-based active surveillance. Clin Infect Dis.\u20081999;29:1164\u20131170","DOI":"10.1086\/313450"},{"key":"2021120901580069000_R33","doi-asserted-by":"crossref","unstructured":"Benjamin DK, Stoll BJ, Fanaroff AA, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics.\u20082006;117:84\u201392","DOI":"10.1542\/peds.2004-2292"},{"key":"2021120901580069000_R34","doi-asserted-by":"crossref","unstructured":"Cotch MF, Hillier SL, Gibbs RS, Eschenbach DA. Epidemiology and outcomes associated with moderate to heavy Candida colonization during pregnancy. Am J Obstet Gynecol.\u20081998;178:374\u2013380","DOI":"10.1016\/S0002-9378(98)80028-8"},{"key":"2021120901580069000_R35","doi-asserted-by":"crossref","unstructured":"Blakely ML, Lally KP, McDonald S, et al. Postoperative outcomes of extremely low birth weight infants with necrotizing enterocolitis or isolated intestinal perforation. Ann Surg.\u20082005;241:984\u2013994","DOI":"10.1097\/01.sla.0000164181.67862.7f"},{"key":"2021120901580069000_R36","doi-asserted-by":"crossref","unstructured":"Blakely ML, Tyson JE, Lally KP et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics.\u20082006;117(4). Available at: www.pediatrics.org\/cgi\/content\/full\/117\/4\/e680","DOI":"10.1542\/peds.2005-1273"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/120\/6\/e1458\/1175067\/zpe012070e1458.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/120\/6\/e1458\/1175067\/zpe012070e1458.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,14]],"date-time":"2023-05-14T17:53:02Z","timestamp":1684086782000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/120\/6\/e1458\/70528\/Maternal-Factors-in-Extremely-Low-Birth-Weight"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,12,1]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2007,12,1]]},"published-print":{"date-parts":[[2007,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2006-2804","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,12,1]]}}}