Ultrasound to diagnose spontaneous intestinal perforation in infants weighing ⩽ 1000 g at birth.

Abstract

To evaluate the usefulness of abdominal ultrasound in infants with gasless abdomen radiographically suspected to have spontaneous intestinal perforation (SIP). This was a retrospective analysis of data from our neonatal database including infants with birth weight ⩽ 1000 g with suspicion of SIP, for the period January 2000 to May 2012. Four hundred and ninety-six infants weighing ⩽ 1000 g were identified. There were 68 infants with suspicion for SIP, 11 with pneumoperitoneum and 57 with gasless abdomen on X-rays. Ultrasound was performed in 55 of 57 infants with gasless abdomen, 10 with SIP and 45 nonperforated. Echogenic free fluid (EFF) was present in 70% of patients with SIP and 11% of nonperforated patients (P<0.001). When performed within 2 days of surgical diagnosis, EFF had 100% sensitivity and 89% specificity, with 58% positive predictive value and 100% negative predictive value. These data suggest that abdominal ultrasound may be useful for the diagnosis of SIP in infants with birth weight ⩽ 1000 g presenting with gasless abdomen.