[Perforated gastric ulcer: an increasing neonatal ICU disease? Report of 4 cases]

Between november 1994 and september 1995, there were 4 cases of premature infants in our Neonatal Intensive Care Unit (NICU) who developed gastrointestinal perforation and bleeding due to peptic ulcer and 3 died of this complication. In the first case, the neonate developed pneumoperitonium when weaning from the ventilator and was submitted to the operation with clinical diagnosis of Necrotizing Enterocolitis. Surprisingly, during the procedure, a perforated gastric ulcer was disclosed. Ever since, this NICU is aware of this diagnosis and try to better identify the possible risks factors. Asphyxia, prematurity, stress and situations where low gastrointestinal flow (asphyxia, exchange transfusion, pneumothorax, hemodynamic shock, cardiac arrest) were observed in almost every case. Treatment with dexamethasone or aminophilline was used in 3 of 4 cases and this potential serious side effect should be considered in all babies treated with steroids. The association of ranitidine (2 mg/kg 12/12 h) could not prevent the perforation in cases 1 and 3. Better understanding of physiopathology of the ulcer in this period of life and a effective preventable drug is still lacking.