Frequency of Small Bowel Perforation among Neonates Presented with Pneumoperitoneum: A Cross Sectional Study

Abstract

Background: Neonatal pneumoperitoneum, characterized by the presence of free gas within the peritoneal cavity, is a critical condition often signaling intestinal perforation. While necrotizing enterocolitis (NEC) has been predominantly associated with this condition, various other etiologies contributing to neonatal intestinal perforations necessitate further exploration. The management of such conditions, particularly in resource-limited settings, remains a challenge, often resulting in significant morbidity and mortality. Objective: This study aims to investigate the frequency of small bowel perforation among neonates presenting with pneumoperitoneum and to examine the association between neonatal weight and the occurrence of small bowel perforation. Methods: A cross-sectional study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from July 2023 to December 2023. Seventy neonates aged 5 to 25 days presenting with radiological evidence of pneumoperitoneum were included. Demographic details were collected, and the infants underwent primary peritoneal drainage followed by exploratory laparotomy if necessary. Data analysis was performed using SPSS version 25, employing Chi-Square tests for categorical variables, with a significance level set at p < 0.05. Results: Of the 70 neonates, 20 (28.6%) were diagnosed with small bowel perforation. A significant association was found between small bowel perforation and neonatal weight; 13 (65%) of the perforation cases were among neonates weighing less than 2.5 kg (p = 0.0001). The overall mortality rate observed was 35%, with 20 neonates succumbing shortly after peritoneal drain insertion due to sepsis. Conclusion: Small bowel perforation is a significant complication in neonates with pneumoperitoneum, with a higher incidence observed in those with lower birth weights. This study highlights the critical need for immediate diagnosis and intervention in such cases, particularly in under-resourced settings, to improve outcomes.