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Neonatal gastrointestinal perforations
D St-Vil1, G LeBouthillier, F I Luks
1Department of Surgery, Hôpital Ste-Justine, Montreal, Quebec, Canada.
Insights
Neonatal gastrointestinal perforation remains a serious condition with a 36% mortality rate, primarily driven by necrotizing enterocolitis (NEC). While survival has not significantly improved, prognostic factors beyond birth weight are becoming more critical.
Area of Science:
- Neonatal Surgery
- Pediatric Gastroenterology
- Critical Care Medicine
Background:
- Neonatal gastrointestinal perforation carries a high mortality rate, ranging from 40% to 70%.
- Necrotizing enterocolitis (NEC) is a leading cause of perforation in neonates.
- Past treatment strategies have focused on surgical intervention, with varying outcomes.
Purpose of the Study:
- To analyze the outcomes of neonatal gastrointestinal perforation over a 20-year period.
- To identify the primary etiologies and prognostic factors associated with neonatal gastrointestinal perforation.
- To evaluate trends in mortality and survival rates in this patient population.
Main Methods:
- Retrospective review of 81 infants treated for gastrointestinal perforation.
- Classification of etiologies including necrotizing enterocolitis, meconium ileus, and idiopathic gastric perforation.
- Comparison of outcomes between surgical exploration and peritoneal lavage, and analysis of mortality based on etiology and birth weight.
Main Results:
- Overall mortality was 36% (29 deaths) in 81 treated infants.
- Necrotizing enterocolitis (NEC) accounted for 68% of perforations and 90% of deaths.
- All patients with idiopathic gastric perforations survived, and the mortality gap between low and normal birth weight infants narrowed.
Conclusions:
- Neonatal gastrointestinal perforation, particularly NEC-related, continues to have a significant mortality rate.
- Etiology and perforation site are increasingly important prognostic indicators, surpassing birth weight.
- Despite advances, survival rates have not markedly improved, necessitating further research into underlying causes and targeted interventions.
Abstract:
Neonatal gastrointestinal perforation has been associated with mortality rates of 40% to 70%. Over the past 20 years, 81 infants (46 boys and 35 girls) were treated for a gastrointestinal perforation at this institution. Perforation occurred from birth to 50 days (average, 8.2 days). Etiologies included necrotizing enterocolitis (NEC) (68%), meconium ileus (10%), and idiopathic gastric perforation (7%). Seventy-six infants underwent surgical exploration and five infants, considered too small or too sick to withstand a laparotomy, were treated with peritoneal lavage only. There were 29 deaths, an overall mortality of 36%. Ninety percent of the death occurred in patients with NEC, while all patients with gastric perforations survived. There has not been a significant improvement in survival in recent years, partly because of an increase in the proportion of NEC-related perforations. However, there is a narrowing of the mortality gap between low birth weight and normal weight infants. As the risk inherent to laparotomy in neonates is decreasing, other factors, such as the underlying etiology or the site of perforation, play a more important prognostic role.