[Bowel perforation in the newborn baby]

The pattern of neonatal gastrointestinal perforation has changed with the previous high frequency of gastric rupture being replaced by necrotizing enterocolitis (NEC) in recent years. NEC has become the most common cause of gastrointestinal perforation resulting in a surgical emergency in the Neonatal Intensive Care Unit (NICU). Over the last 20 years, the infant mortality rate attributable to NEC has not decreased. However, in our institutions, more than 70% of babies with NEC are premature infants weighing less than 1,000g, which is one of the main reasons why the mortality rate due to neonatal gastrointestinal perforation has not improved in recent years. NEC totalis or massive necrosis of nearly all of the intestine is uniformly fatal. Limited resection followed by second-look laparotomy after abdominal drainage is one method used to limit the length of intestinal resection but most of these infants died from sepsis with cardiovascular collapse and multisystem organ failure. Among extremely low birth weight infants surviving after NEC significant growth delay and adverse neurodevelopmental outcome are common sequelae. More recently, many extremely low birth-weight infants are commenced on early low-volume feeds of breast milk or probiotics. This appears to be reducing the incidence of NEC and may explain a drop in the mortality rate over the last five years.