PRETERM infants face an increased risk of developing appendicitis during their first year of life, according to new research.
Study author Yakun Liu, Children’s Hospital of Soochow University, Jiangsu, China, and colleagues, explained that bacterial invasive infections were historically thought to be critical risk factors for the development and progression of appendicitis. “Given heightened susceptibility to infections due to an immature immune system in preterm infants, it is hypothesised that they may be at an elevated risk for appendicitis,” they wrote.
The research team conducted a retrospective, multicentre, matched case-control study to investigate the association between preterm birth and infantile appendicitis. They included 106 infants diagnosed with appendicitis (median age: 2.4 months; 68.9% male; 34% history of preterm birth) and 1,060 healthy controls (median age: 2.5 months; 54.6% male; 11.6% history of preterm birth). Infants were categorised as neonates (0–28 days) or older infants (>28 days and <1 year).
Using a univariate analysis, the authors found that preterm birth was significantly associated with the development of appendicitis within the first year of life (odds ratio [OR]: 4.23; 95% confidence interval [CI]: 2.67–6.70). Additional factors associated with a higher risk of infantile appendicitis included male sex (OR: 1.91; 95% CI: 1.25–2.94), weight-for-age z-score (OR: 0.72; 95% CI: 0.64–0.81), and being exclusively fed on formula (OR: 2.95; 95% CI: 1.77–4.91). Preterm birth remained significantly associated with appendicitis in multivariable analyses (adjusted OR: 3.32; 95% CI: 1.76–6.24), and subgroup analysis revealed that a preterm birth history increased the risk of appendicitis both in neonates (adjusted OR: 4.56; 95% CI: 2.14–9.71), and in older infants (adjusted OR: 3.63; 95% CI: 1.72–7.65).
Although 72.6% of the infants with appendicitis presented with a perforated appendicitis, preterm birth history was not found to be associated with perforation incidence (OR: 0.79; 95% CI: 0.32–1.91).
In response to these findings, Liu and colleagues emphasised that a preterm history should be considered in the diagnostic algorithm of infantile appendicitis. “Future studies are warranted to extend the knowledge of infantile appendicitis and promote timely diagnosis,” they concluded.
