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Gastro-intestinal tract perforation in neonates
R T Kuremu1, G P Hadley, R Wiersma
1Department of Surgery, Faculty of Health Sciences, Moi University, PO Box 4606, Eldoret, Kenya.
East African Medical Journal
|December 3, 2003
Summary
Neonatal gastro-intestinal tract perforation has high mortality, often due to sepsis. Early recognition of primary conditions and prompt management, especially for neonates with respiratory issues, can improve survival rates.
Area of Science:
- Neonatal Surgery
- Pediatric Gastroenterology
- Public Health
Background:
- Neonatal gastro-intestinal tract (GIT) perforation presents a significant health challenge, characterized by high mortality rates primarily linked to sepsis.
- Co-morbidities such as prematurity, low birth weight, and respiratory or nutritional issues exacerbate the poor outcomes associated with GIT perforation in newborns.
Purpose of the Study:
- To evaluate the management outcomes for neonates experiencing gastro-intestinal tract perforation within KwaZulu-Natal.
- To pinpoint critical factors that necessitate focused attention to enhance the survival rates of neonates diagnosed with GIT perforation.
Main Methods:
- A retrospective analysis was conducted on a cohort of 54 neonates treated for gastro-intestinal tract perforation between January 1998 and January 2003.
- Data were collected from complete patient records, focusing on morbidity determined by complications and mortality.
Main Results:
- The study identified males (69%) as more frequently affected than females (31%), with a median birth weight of 2.3 kg and presentation at four days of age.
- Abdominal distension was the predominant symptom (74%), and prematurity was the leading co-morbidity (52%). Necrotising enterocolitis (NEC) was the primary cause of perforation (33%), most commonly in the terminal ileum.
- Sepsis emerged as the leading complication (44%) and the primary cause of death (72%), contributing to an overall mortality rate of 46%.
Conclusions:
- Preventing secondary perforations through early detection and management of primary pathologies is crucial.
- Resuscitation protocols for neonates with respiratory difficulties should incorporate the management of pneumoperitoneum prior to transfer.
- Practices such as rectal temperature monitoring and the use of herbal enemas should be strongly discouraged in neonatal care.