Spontaneous intestinal perforation in premature infants: A distinct clinical entity associated with systemic candidiasis

Abstract

Purpose: The aim of this study was to define patient characteristics, risk factors, microbiology, and outcome of spontaneous intestinal perforations (SIP) in premature infants. Methods: To identify the characteristics and frequency of SIP, the medical records of 94 premature infants were reviewed retrospectively. Results: Eleven infants experienced 12 episodes of SIP and 53 infants had 55 episodes of confirmed necrotizing enterocolitis (NEC). Compared with infants who had NEC, the infants with SIP were smaller and born more prematurely. The onset of illness was earlier and was associated with antecedent hypotension, leukocytosis, and a gasless appearance on abdominal radiograph. Blue abdominal discoloration was present in 11 of 12 babies with SIP, but in only one of the babies with NEC. Infants with SIP were significantly more likely to have systemic candidiasis. When controlling for birth weight and age, early onset, blue abdomen, and a gasless abdominal radiograph continued to be statistically significant markers of SIP. Conclusions: SIP occurs about 12-fold less frequently than NEC in preterm infants. A combination of clinical, laboratory, and radiological features distinguish very low birthweight infants with SIP from those with NEC. Obvious signs of bowel perforation are infrequent with SIP. SIP is frequently associated with systemic candidiasis.