Etiology and prognosis of neonatal gastrointestinal perforation: an analysis of 206 cases

Abstract

Objective To study the etiology, diagnosis, treatment and prognosis of neonatal gastrointestinal perforation. Methods From July 2010 to June 2014, the medical records of neonates with gastrointestinal perforation admitted to the neonatal surgery and neonatal intensive care unit were retrospectively reviewed.Their medical records including demographic information, perioperative information and prognosis were analyzed and compared between term and preterm infants. Results Among 206 patients reviewed, 158 were male and 48 female, 119 were preterm infants and 87 term infants.The average birth weight of participants was (2 500±210)g, ranging from 960g to 5 130g.The body weight at admission was (2 410±190)g, ranging from 940g to 5 650g.Age of onset ranged from 7 hours to 27 days(median: 5.35 days).141 patients were cured or had improved prognosis.189 patients received operation, 3 patients were treated conservatively, and the other 14 patients refused to accept operative therapy.Common presentations included abdominal distension (96.1%), poor appetiteor vomiting (68.9%). The majority of causes in preterm infants included congenital absence of muscular structures of the stomach, neonatal necrotizing enterocolitis (NEC) and enteric neuronal dysplasia, while congenital megacolon and NEC in term infants.Gastric perforation group and bowel perforation group had similar preterm infants ratio and no significant differences existed on the outcomes of preterm and term infants (P>0.05). Main causes of death/withdraw were severe infectionand multiple organ dysfunction resulting from delayed diagnosis or operation. Conclusion Neonatal gastrointestinal perforation occurs more commonly in males than in females.Preterm infants have higher risk developing gastrointestinal perforation. When a newborn less than one week presents with abdominal distension or vomiting, gastrointestinal perforation should be excluded first. Key words: Intestinal perforation; Gastrointestinal diseases; Pneumoperitoneum; Gastric perforation; Enterocolitis, necrotizing