Related Experiment Videos
Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years
J L Grosfeld1, F Molinari, M Chaet
1Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
Insights
Gastrointestinal perforation is common in premature infants, with necrotizing enterocolitis (NEC) causing the highest mortality. Despite advanced care, outcomes for these vulnerable infants remain poor.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Gastrointestinal perforation and peritonitis present significant mortality risks in premature infants.
- This study investigates etiologic factors and outcomes in 179 patients to identify predictors of survival.
Purpose of the Study:
- Compare mortality and causes of death between premature infants and older children with gastrointestinal perforation.
- Identify specific risk factors and outcomes associated with necrotizing enterocolitis (NEC) in neonates.
Main Methods:
- Retrospective analysis of 179 patients (newborn to 17 years) with gastrointestinal perforation.
- Categorization of perforation sites, etiologic factors, and patient demographics (gestational age, birth weight).
Main Results:
- Mortality rates were highest in premature infants with NEC (48%) compared to non-NEC infants (27.2%) and older children (15.1%).
- Sepsis, systemic immaturity, and multiorgan failure were primary causes of death in infants.
- Older children's deaths were attributed to sepsis, multiorgan failure, and immunodeficiency.
Conclusions:
- Gastrointestinal perforation is more prevalent in premature infants, particularly those with NEC, who experience the highest mortality.
- Advances in neonatal intensive care have not significantly reduced the high mortality rates for premature, low-birth-weight infants with NEC.
Background:
Premature infants continue to have a high mortality after gastrointestinal perforation. This report describes 179 patients with gastrointestinal perforation and peritonitis and compares etiologic factors, mortality, and causes of death in premature infants and older children in an attempt to predict outcome.
Methods:
The 113 boys (63.1%) and 66 girls (36.9%) had an age range of newborn (n = 139, 77.6%) to 17 years. Site of perforation was gastric in 16, duodenal in 9, small bowel in 105, colon in 37, and undesignated in 12. Eighteen had multiple perforations. Etiologic factors in newborns (younger than 2 months) included necrotizing enterocolitis (NEC) (75, 41.9%), isolated ileal perforations (30, 21.5%), malrotation/volvulus (8), iatrogenic causes (5), and others (6). Gestational age was 29.6 +/- 4.3 weeks for NEC versus 31.4 +/- 5.4 weeks for non-NEC. Birth weight for patients with NEC was 1.45 +/- 0.8 gm and 1.81 +/- 1.0 gm for non-NEC babies. Etiologic factors in 33 older children (older than 2 months to 17 years) were trauma (10), Meckel's diverticulum (4), intussusception (2), pseudomembranous colitis (2), adhesions (2), stomal leak (2), others (4), and nondesignated (7). Gastric perforations (n = 16) were iatrogenic in 7, idiopathic in 5, and caused by an ulcer in 4.
Results:
Mortality for NEC was 36 of 75 (48%), 15 of 55 (27.2%) for non-NEC infants (p < 0.05 versus NEC), 15.1% (5 of 33) for older children (p < 0.05 versus NEC), and 4 of 16 (25%) for gastric perforation. Infant deaths were related to overwhelming sepsis, immaturity of systems, and multiorgan failure. Deaths for older children were a result of sepsis, multiorgan failure, and immunodeficiency.
Conclusions:
Gastrointestinal perforation is more common in premature infants with the highest mortality (48%) noted in NEC. Despite surgical intervention and advances in neonatal intensive care unit care, premature low birth weight infants (especially NEC) continue to have a high mortality.