Incidence of septicemia immediately after elective gastrointestinal contrast procedures in infants: a cohort study

Abstract 

Background

Sepsis is a documented complication of gastrointestinal contrast procedures in neonates. However, the identification of preventive measures is hampered by a lack of data on its incidence and risk factors.

Methods

The study used a retrospective cohort analysis of infants with selected surgical gastrointestinal conditions admitted to a tertiary neonatal center. Risk factors were identified by logistic regression and matched case-control analyses. Contrast procedure-related bacteremia or sepsis were defined by clinical signs with or without a positive blood culture, respectively, within 48 hours after an intervention.

Results

The apparent incidence of contrast procedure-related sepsis was 2.7 per 100 infant procedures. Infants with contrast procedure-related sepsis were also generally of lower gestational age and birth weight and generally sicker (ie, higher incidence of hepatic cholestatic disease, and poorer weight gain). Notably, all infants with contrast procedure-related sepsis previously had necrotizing enterocolitis. Although the number of cases of sepsis directly attributable to the procedures may be lower, as suggested by a comparison with the baseline time prevalence of bacteremia in this cohort, significant associated morbidities and mortality were observed.

Conclusions

This is the first study reporting the incidence of contrast procedure-related sepsis in high-risk infants with surgical gastrointestinal conditions. Based on our observations, the routine use of prophylactic antibiotics to prevent this complication in this population does not seem warranted.

Key words: Neonates, Gastrointestinal surgery, Radiologic contrast procedure, Sepsis