Neonatal gastrointestinal perforations: a 7-year single center experience at a tertiary neonatal intensive care unit in Turkey (original) (raw)

Gastrointestinal perforations in newborns with high mortality: A series of 18 cases

Journal of Neonatal Surgery

Gastrointestinal perforations (GIP) in newborns are serious neonatal conditions that have significant morbidity and mortality, especially in resource constrained setups. This study was done to describe our experience of GIP in neonates and identify the factors leading to high mortality in our setup. We collected 18 cases with GIP in neonates. The average age was 5.7 days (range, 1-7 days). The sex ratio was 0.64. The average time to treatment was 3.3 days (range, 1-10 days). The etiology of GIP was perforated necrotizing enterocolitis (13 patients), spontaneous gastric perforation (2 patients), perforated ileal atresia (1 patient), ileal perforation complicating a strangulated inguinoscrotal hernia (1 patient), and peritonitis after colostomy (1 patient). Mortality was 77.8% (n=14), among which 9 newborns (64.3%) died preoperatively. Prematurity, management delay, and lack of a neonatal intensive care unit were the main poor prognostic factors. Mortality from GIP is still high in ou...

Gastrointestinal Perforation in Neonates: Aetiology and Risk factors

ABSTRACT Background: Gastrointestinal perforation (GIP) in neonates presents important challenges and mortality can be high. This is a report of recent experience with GIP in neonate s in a developing country. Patients and methods: A retrospective review of 16 neonates treated for GIP in a 3 year period. Results: There were 9 males and 7 females, aged 028 days (median age =7days). Their weights at presentation ranged from 0.9 4.7kg (median =2.6). Five infants were premature. Twelve infants presented more than 72 hours after onset of symptoms. Plain abdominal radiographs showed peumoperitoneum in 9 infants. The cause of perforation was necrotising enterocolitis 6, intestinal obstruction 6, iatrogenic 3 and spontaneous 1. The site of perforation was ileum in 12 infants, stomach in 4 and colon in 4; 4 pat ients had involvement of more than one site. All the neonates underwent exploratory laparotomy with primary closure ( n=5) , resection and anastomosis( n=6), colostomy (n=3), Ileostom...

Final Neonatal GI Perforations -papar.docx

Objective: To look for pathological causes of Gastrointestinal perforations in neonates and evaluation of current modalities of surgical management and their outcome. Design: Retrospective study Place & Duration of study: Department of Pediatric Surgery , The Children’s Hospital & the institute of child health , Lahore Pakistan. Patients and Methods: Between January 2011 to January 2013, a total of forty eight neonates with GI perforations were managed .Birth weight, age, clinical presentation, etiology, site of perforation, surgical management performed and complications encountered are analyzed. Results: 60% of patients (28/48) had appropriate birth weight where as 31% (14/48) had low birth weight. Most of the patients (35/48) were males. Exclusive number (83%) i.e 38 out of total of 48 presented in first week of life. Most of the patients presented with abdominal distension, vomiting, constipation and septicemia. Apart from usual investigations, exploration was performed on the basis of pneumoperitoneum on abdominal x-rays. There were 28 cases of NEC, 10 of meconeum ileus, 03 with gastric perforation and 04 of anorectal malformations. 2 cases of colonic atresia and 1 of Hirschsprung's disease were included in the study. The complications encountered in these cases included septicemia, abdominal wound infection, leakage of anastomosis and stoma related complications like bleeding, necrosis and retraction. The mortality in study was 16 patients comprising 09 cases of NEC ,5 cases of complicated meconeum ileus, 01 case of imperforate anus and 01 case of colonic atresia . Conclusion: Gastrointestinal perforation in the neonatal age is a common manifestation of various disease entities and management of these neonates requires understanding of these pathological entities. Septicemia and late presentation of patients to hospital is responsible for high morbidity and mortality in these tiny sick neonates in our setup. Keywords: Gastrointestinal perforation, Neonate, Pneumoperitoneum.

Comparison of Perforated Necrotizing Enterocolitis in Full-Term and Preterm Infants

Although necrotizing enterocolitis (NEC) is a primary disease of prematurity, full-term infants account for approximately 10% of cases. We retrospectively reviewed the medical records of infants with perforated NEC at two tertiary medical centers over the past fifteen years. Nine full-term and 29 pre-term infants with perforated NEC were enrolled in our study. Among the full-term cases, 4 were older than one month. Perforated NEC was male predominant in pre-term cases and female predominant in full-term cases. Abdominal distention, abdominal wall discoloration and muscle guarding were the most common manifestations in preterm cases, and abdominal distension and bloody stool were most common in full-term cases. The most common abnormal laboratory findings were anemia and metabolic acidosis in preterm cases, and leucocytosis and metabolic acidosis in full-term cases. In pre-term infants, the most common related factors were prenatal problems and maternal disease (19/29, 65.5%), patent ductus arteriosus with indomethacin use (14/29, 48.3%), and sepsis (11/29, 37.9%). In full-term cases, congenital anomaly (5/9, 55.6%) and sepsis (3/9, 33.3%) were the most common related factors, especially in full-term infants older than 1 month. The most common pathogen cultured from patients' blood or ascites was Klebsiella pneumoniae, followed by E. coli, in both pre-term and full-term infants. In conclusion, perforated NEC should be considered in both preterm and full-term babies if infants present with signs of surgical abdomen. To reduce NEC mortality and morbidity in both preterm and full-term infants, early diagnosis and treatment are vitally important, especially in cases with predisposing factors. (Clinical Neonatology 2007;14:75-80)

Comparative Study between Isolated Intestinal Perforation and Necrotizing Enterocolitis

European Journal of Pediatric Surgery, 2005

Introduction: Intestinal perforations in the neonatal period are usually related to necrotizing enterocolitis (NEC) or intestinal occlusion. Intestinal perforation in the absence of these conditions is called isolated perforation (IP). Several risk factors and pathogenic mechanisms have been suggested, and most of them are common to those classically attributed to NEC. Aim: To identify and compare the clinical and pathological features of IP and NEC. Material and Methods: We reviewed all cases of neonatal intestinal peforation and NEC in the last five years. Thirty-three patients were retrospectively classified into Group NEC: 24 cases, and Group IP: 9 cases. We collected multiple data as study variables: 1) General features; 2) Obstetric history; 3) Neonatal treatment; 4) Comorbidity; 5) Perforation features; 6) Treatment and outcome. Results: Comparing the groups, we found statistical significant differences in isolated perforation cases with these risk factors: extreme prematurity, very low birth weight, abruptio placenta, intubation and neonatal mechanical ventilation, umbilical catheterization, precocious sepsis, and indomethacin therapy. A more precocious operation and a good prognosis also reached statistical significance. In the other hand, we found statistically significant differences in NEC with congenital cardiopathy (excluding isolated patent ductus arteriosus), with intestinal pneumatosis, with diffuse bowel involvement and a worse prognosis. Risk factors and pathologic findings seem to support an ischaemic pathogenesis in both diseases.

Intestinal perforation in very preterm neonates: risk factors and outcomes

on behalf of the Canadian Neonatal Network 7 OBJECTIVE: To compare neonatal outcomes of preterm infants (born at o32 weeks' gestation) with focal/spontaneous intestinal perforation (SIP), necrotizing enterocolitis (NEC)-related perforation, NEC without perforation or no NEC/perforation. STUDY DESIGN: Retrospective cohort study of 17 426 infants admitted to Canadian neonatal intensive care units during 2010 to 2013. The primary outcome was a composite of mortality or morbidity (bronchopulmonary dysplasia, severe retinopathy, periventricular leukomalacia or nosocomial infection). Association of intestinal perforation with neonatal outcome was evaluated using multivariate logistic regression. RESULT: SIP was present in 178 (1.0%) infants, NEC-related perforation in 246 (1.4%) and NEC without perforation in 538 (3.1%). Any intestinal perforation was associated with higher odds of the composite outcome (adjusted odds ratio (AOR): 8.21, 95% confidence interval (95% CI) 6.26 to 10.8); however, the odds were significantly lower for focal/SIP compared with NEC-related perforation (AOR: 0.29, 95% CI 0.17 to 0.51). CONCLUSION: Of the two types of intestinal perforation, NEC-related perforation was associated with the highest risk of an adverse neonatal outcome.

Neonatal intestinal perforation in a developing country

Annals of Tropical Paediatrics: International Child Health, 2001

Median age at presentation was 9 days and median weight 2.65 kg. Five had high anorectal malformation, three Hirschsprung's disease and two ruptured exomphalos with bowel strangulation. Gastroschisis, strangulated inguinal hernia, ileal atresia and umbilical sepsis with evisceration accounted for one case each. Two of the perforations were iatrogenic during colostomy construction. Seven perforations were in the small bowel and seven in the colorectum. Three neonates had oedema and tenderness of the anterior abdominal wall, and pneumoperitoneum was seen in abdominal radiographs in two. All the infants had laparotomy, four under local anaesthesia, after resuscitation. Three had simple suture of the perforation, ve had resection with primary anastomosis and six had exteriorization colostomy. Overall, eight (59%) died, ve with colorectal perforation and three with small bowel perforation.

Intestinal perforation in very-low-birth-weight infants with necrotizing enterocolitis

Journal of Pediatric Surgery, 2013

To identify risk factors for intestinal perforation in very-low-birth-weight (VLBW) infants with necrotizing enterocolitis (NEC). Methods: Retrospective case-control study over a 10-year period, using univariate and multivariate logistic regression analyses to compare all VLBW infants treated for perforated NEC, with two age and weight-matched groups: infants with non-perforated NEC and infants without NEC. Results: Twenty infants with perforated NEC were matched to 20 infants with non-perforated NEC and 38 infants without NEC. Infants with perforated NEC were younger (pb0.01) and had higher rates of abdominal distention, metabolic acidosis, hyperglycemia and elevated liver enzymes (pb0.05). On logistic regression analysis, abdominal distention was associated with an increased risk of intestinal perforation (OR 39.8, 95% CI 2.71-585) and late onset of NEC (one-day increments) was associated with a decreased risk (OR 0.93, 95% CI 0.87-1.0). Conclusion: Identification of abdominal distention at an early age in VLBW infants should lead to increased vigilance for signs of perforated NEC and may enable early intervention.