Spontaneous Intestinal Perforation: The Long-Term Outcome

Area of Science:

• Neonatal surgery
• Pediatric gastroenterology
• Neonatal intensive care

Background:

• Spontaneous intestinal perforation (SIP) is a critical surgical emergency in neonates.
• Extremely low birth weight (ELBW) infants are particularly vulnerable to SIP.
• Understanding long-term outcomes is crucial for improving patient management.

Purpose of the Study:

• To evaluate the long-term outcomes of infants treated for spontaneous intestinal perforation (SIP).
• To identify risk factors and common sites of perforation in SIP.
• To assess the incidence of associated conditions like intraventricular hemorrhage (IVH) and long-term disabilities.

Main Methods:

• Retrospective study of all patients treated for SIP between 2005 and 2014.
• Analysis of patient demographics, gestational age, birth weight, and co-morbidities.
• Long-term follow-up to assess neurological development and surgical complications.

Main Results:

• The cohort included 23 infants, predominantly ELBW (74%) with a median gestational age of 26 weeks.
• Patent ductus arteriosus (PDA) was common (70%), and 44% developed intraventricular hemorrhage (IVH), often preceding perforation.
• Ileal perforation (88%) was most frequent; 8.7% of male infants died, and 26% developed moderate to severe disabilities, including cerebral palsy.

Conclusions:

• ELBW is the primary risk factor for SIP.
• IVH is a frequent comorbidity, often occurring before perforation.
• Significant long-term neurological disabilities affect over a quarter of survivors, with males disproportionately affected. Surgical risks are minimal.