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Gastrointestinal perforation in infants.

A P Borzotta1, D B Groff

  • 1Department of Surgery, University of Louisville School of Medicine, Kentucky.

American Journal of Surgery
|March 1, 1988
PubMed
Summary
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Neonatal intestinal perforation is a serious condition, especially in premature infants under 1,000g. However, survival rates can be improved with medical and surgical interventions for gastrointestinal perforation.

Area of Science:

  • Neonatology
  • Pediatric Surgery
  • Gastroenterology

Background:

  • Neonatal intestinal perforation is a critical surgical emergency.
  • Premature infants, particularly those weighing less than 1,000 grams, face the highest risk.
  • Associated conditions like necrotizing enterocolitis and iatrogenic injuries significantly impact outcomes.

Purpose of the Study:

  • To analyze the causes, risk factors, and outcomes of neonatal intestinal perforation.
  • To compare mortality rates across different causes and infant weight classes.
  • To highlight the importance of preventative measures for iatrogenic injuries.

Main Methods:

  • Retrospective analysis of neonatal intestinal perforation cases.
  • Categorization of perforations by etiology (necrotizing enterocolitis, mechanical, iatrogenic, asphyxial/ischemic).

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  • Comparison of mortality and survival rates based on gestational age, birth weight, and perforation cause.

    • Main Results:

    • Mortality rates for necrotizing enterocolitis-related perforation were similar to other causes in comparable weight classes.
    • Iatrogenic injuries presented a 50% mortality rate across all categories.
    • Premature infants (<1,000g) had a significantly lower survival rate (20%) compared to overall (59%) and term infants (78%).
    • Mechanical causes predominated in term infants (foregut/proximal midgut), while asphyxial/ischemic events were common in premature infants (ileocolic region).
    • Intracerebral hemorrhage and bronchopulmonary dysplasia contributed to mortality in low-birth-weight infants.

    Conclusions:

    • Neonatal intestinal perforation is a catastrophic event, with extremely low birth weight infants being most vulnerable.
    • Preventing iatrogenic injuries through careful monitoring and therapeutic interventions is crucial.
    • Despite challenges, medical and surgical interventions offer salvage opportunities for premature infants with gastrointestinal perforation.