Preterm Birth and Infantile Appendicitis

OBJECTIVE To investigate the potential association between preterm birth and infantile appendicitis. METHODS We conducted a retrospective, multicenter, matched case-control study. This study included consecutive patients <1 year of age with surgery- or autopsy-confirmed appendicitis, admitted between December 2007 and May 2023. For each case, 10 healthy infants were randomly selected and matched by age. Infants were categorized as neonates (0 to 28 days) or older infants (>28 days and <1 year). RESULTS The study included 106 infants diagnosed with appendicitis (median age 2.4 months) and 1060 age-matched healthy controls. In the univariate analysis, 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). Other factors associated with a higher risk of infantile appendicitis included being male (OR, 1.91; 95%CI, 1.25–2.94), weight-for-age z-score (OR, 0.72; 95%CI, 0.64–0.81), and exclusively fed on formula (OR, 2.95; 95%CI, 1.77–4.91). In multivariable analyses, preterm remained significantly associated with appendicitis (adjusted OR, 3.32; 95%CI, 1.76–6.24). Subgroup analysis revealed that a preterm birth history increased the risk of appendicitis in both neonates (adjusted OR, 4.56; 95%CI, 2.14–9.71) and older infants (adjusted OR, 3.63; 95%CI, 1.72–7.65). However, preterm did not significantly influence the incidence of appendiceal perforation. CONCLUSIONS Preterm infants have an increased risk of appendicitis during the first year of life. A preterm birth history may help improve the timely diagnosis of infantile appendicitis.