Abstract
Gastrointestinal perforations (GIP) in newborns are serious neonatal conditions that have significant morbidity and mortality, especially in resource constrained setups. This study was done to describe our experience of GIP in neonates and identify the factors leading to high mortality in our setup. We collected 18 cases with GIP in neonates. The average age was 5.7 days (range, 1-7 days). The sex ratio was 0.64. The average time to treatment was 3.3 days (range, 1-10 days). The etiology of GIP was perforated necrotizing enterocolitis (13 patients), spontaneous gastric perforation (2 patients), perforated ileal atresia (1 patient), ileal perforation complicating a strangulated inguinoscrotal hernia (1 patient), and peritonitis after colostomy (1 patient). Mortality was 77.8% (n=14), among which 9 newborns (64.3%) died preoperatively. Prematurity, management delay, and lack of a neonatal intensive care unit were the main poor prognostic factors. Mortality from GIP is still high in our context due to several factors, especially prematurity, management delay, and lack of a neonatal intensive care unit.
Highlights
Gastrointestinal perforations (GIP) in newborns are serious conditions and categorized as spontaneous perforations and perforations caused by an underlying pathology.[1,2,3] Among secondary perforations, necrotizing enterocolitis (NEC) is the most common cause of GIP.[4,5] Irrespective of the cause, a delay in the diagnosis and management leads to poor prognosis.[4]
Cases of NEC in which peritoneal drainage was performed, 2 cases of NEC treated by immediate resection-anastomosis, 2 cases of gastric perforations treated by primary repair with omentoplasty, 1 case of strangulated hernia complicated by ileal perforation treated by immediate resection-anastomosis, and 1 case of perforated ileal atresia treated by resectionanastomosis
Nine neonates died before any kind of surgery including 8 cases of NEC, and 1 case of peritonitis after colostomy
Summary
Gastrointestinal perforations (GIP) in newborns are serious conditions and categorized as spontaneous perforations (without obvious etiology) and perforations caused by an underlying pathology (secondary).[1,2,3] Among secondary perforations, necrotizing enterocolitis (NEC) is the most common cause of GIP.[4,5] Irrespective of the cause, a delay in the diagnosis and management leads to poor prognosis.[4]. Gastrointestinal perforations (GIP) in newborns are serious conditions and categorized as spontaneous perforations (without obvious etiology) and perforations caused by an underlying pathology (secondary).[1,2,3] Among secondary perforations, necrotizing enterocolitis (NEC) is the most common cause of GIP.[4,5] Irrespective of the cause, a delay in the diagnosis and management leads to poor prognosis.[4] In sub-Saharan Africa, factors such as the lack of means and neonatal resuscitation can worsen the prognosis.
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