Abstract
BackgroundThe current standard treatment of neonates with intestinal perforation is surgery. However, the mortality rate after surgical treatment for intestinal perforation is very high for very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates. In this review, conservative treatment of pneumoperitoneum among VLBW and ELBW neonates is investigated.MethodsBetween January 2015 and December 2017, data from all of the VLBW and ELBW neonates with pneumoperitoneum who survived without surgical treatment were collected from Shenzhen Maternity and Child Healthcare Hospital in Guangdong, China. Twenty-two neonates with birth weight less than 1500 g were diagnosed with pneumoperitoneum. Following careful evaluation and discussion, eleven were treated conservatively and this was successful in eight. Details of the eight neonates including birth weight, gestational age, gender, risk factors, time of the perforation, treatment and prognosis were retrospectively recorded. A literature review was performed of previously reported cases that had used conservative treatment.ResultsThe median gestational age and birth weight of the eight neonates were 27+ 1 weeks (range 24w+ 3 to 31w+ 6) and 855 g (range 650 g to 1440 g), respectively. Pneumoperitoneum was confirmed by X-ray in all at a median of 8 days of life. They received full parenteral support for a median of 22 days. All eight neonates received a combination of piperacillin-tazobactam and meropenem as first-choice antibiotics, two of them also received fluconazole as anti-fungal medication. Median duration of hospitalisation was 80 days.ConclusionsConservative treatment with careful surveillance may be a practical choice for the VLBW and ELBW neonates with intestinal perforation. Further studies are needed for confirmation.
Highlights
The current standard treatment of neonates with intestinal perforation is surgery
We noticed that some closely monitored very low birth weight (VLBW)/extremely low birth weight (ELBW) neonates with pneumoperitoneum may gain full recovery without surgical intervention or peritoneal drainage with appropriate nutrition and pharmacological strategies
From January 2015 to December 2017, all preterm neonates of birth weight less than 1500 g diagnosed with intestinal perforation within 2 weeks of birth were reviewed, intestinal malformations were ruled out, and the cases that made a full recovery without surgical intervention were analysed further
Summary
The mortality rate after surgical treatment for intestinal perforation is very high for very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates. Conservative treatment of pneumoperitoneum among VLBW and ELBW neonates is investigated. Intestinal perforation is a severe complication that causes high mortality rates in preterm neonates and is usually characterized by abdominal distension and pneumoperitoneum on abdominal X-rays. The current standard treatment of neonates with intestinal perforation is surgery. Ye et al BMC Pediatrics (2019) 19:255
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