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Focal intestinal perforation in the extremely-low-birth-weight infant
C M Novack1, F Waffarn, J H Sills
1Department of Pediatrics, University of California, Irvine, Orange 92668.
Insights
Extremely-low-birth-weight infants with focal intestinal perforation showed distinct clinical features and higher blood urea nitrogen increases after indomethacin treatment compared to controls. This condition differs from typical necrotizing enterocolitis (NEC).
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Gastroenterology
Background:
- Extremely-low-birth-weight (ELBW) infants are susceptible to gastrointestinal complications.
- Focal intestinal perforation is a serious condition in neonates, often distinct from necrotizing enterocolitis (NEC).
Purpose of the Study:
- To document clinical and laboratory features of ELBW infants with focal intestinal perforation.
- To identify clinical events associated with focal intestinal perforation by comparing affected infants with matched controls.
Main Methods:
- A case-control study involving 11 ELBW infants with focal intestinal perforation and 11 matched ELBW controls without perforation.
- Analysis of clinical data, laboratory values (including response to indomethacin), and microbiological cultures.
Main Results:
- Infants with focal intestinal perforation had a significantly higher percent increase in blood urea nitrogen after indomethacin treatment (p < 0.02).
- Perforations were focal, often multiple, located on the antimesenteric border of the distal ileum, and not consistent with NEC.
- The incidence of focal intestinal perforation was 6% in ELBW infants, compared to 2% for NEC. Positive cultures for Staphylococcus epidermidis or Candida albicans were more frequent in the perforation group (p < 0.09).
Conclusions:
- Focal intestinal perforation in ELBW infants presents with distinct clinical and pathological features compared to typical NEC.
- Indomethacin treatment may be associated with an increased risk of focal intestinal perforation in susceptible ELBW infants.
Abstract:
The purposes of this report were to (1) document the clinical and laboratory features of 11 extremely-low-birth-weight (ELBW) infants with focal intestinal perforation and (2) investigate the clinical events possibly associated with these perforations by examining matched pairs of infants with and without focal intestinal perforation. During the study period 173 infants with birth weights between 600 and 1000 gm were admitted to the neonatal intensive care nursery. Eleven of these ELBW infants had focal intestinal perforations and formed the study group. These infants were matched with 11 ELBW infants who did not have intestinal perforations or signs of inflammatory bowel disease. The matched pairs were similar in all respects except for a significantly higher percent increase in blood urea nitrogen level after treatment with indomethacin (Wilcoxon signed-rank test, p < 0.02) in infants with intestinal perforation. At laparotomy the perforations were noted to be focal, often multiple, and on the antimesenteric border of the distal ileum. None of the infants showed clinical, radiographic, or intraoperative findings that were consistent with classifications for necrotizing enterocolitis (NEC). The incidence of focal intestinal perforation in ELBW infants was 6% versus 2% for typical NEC. In addition, four of the 11 infants with intestinal perforation had positive cultures for either Staphylococcus epidermidis or Candida albicans, whereas none of the infants without perforation had positive cultures during the study period (Fisher's exact test, p < 0.09). We conclude that the clinical presentation and the characteristic intestinal lesions in this group of ELBW infants are distinct from those in typical cases of NEC.(ABSTRACT TRUNCATED AT 250 WORDS)