Spontaneous intestinal perforation of the newborn
- Eugene S Kim, MD
Eugene S Kim, MD
- Associate Professor of Surgery, Division of Pediatric Surgery
- University of Southern California Keck School of Medicine
- Mary L Brandt, MD
Mary L Brandt, MD
- Professor of Surgery, Division of Pediatric Surgery
- Baylor College of Medicine
Spontaneous intestinal perforation (SIP) of the newborn, also referred to as isolated perforation of the newborn, is a single intestinal perforation that is typically found at the terminal ileum [1-5]. SIP occurs primarily in premature infants with very low birth weight (VLBW, birth weight <1500 g) and extremely low birth weight (ELBW, birth weight <1000 g). SIP is a separate clinical entity from necrotizing enterocolitis, the most severe gastrointestinal complication of premature infants. This differentiation is important because of management considerations. (See "Clinical features and diagnosis of necrotizing enterocolitis in newborns".)
The epidemiology, clinical features, diagnosis, and management of spontaneous intestinal perforation of the newborn will be reviewed here.
Spontaneous intestinal perforation (SIP) is most commonly found in very low birth weight (VLBW) and extremely low birth weight (ELBW) premature infants. The risk appears to be about 2 to 3 percent in VLBW infants [1,6,7] and about 5 percent in ELBW infants . The median gestational age varies from 25 to 27 weeks, and median birth weight from 670 to 973 g [1-3,9,10]. SIP occurs more frequently in male infants (ranging from 65 to 71 percent of affected infants) .
Risk factors — Prematurity is the only well established risk factor for SIP. Several reported antenatal and postnatal risk factors are based upon limited data that include findings from case series and a single data set from the Pediatrix Medical Group [1,11-13]. This data set is based upon clinical progress notes of premature infants (range of gestational age 23 to 34 weeks) who were born and cared for at 98 sites in the Pediatrix Medical Group between 1998 and 2000 .
Antenatal — Severe placental chorioamnionitis appears to be an antenatal risk factor for SIP. In one case-control study of 16 premature infants with SIP, infants with SIP versus matched controls were more likely to have severe placental chorioamnionitis with evidence of fetal vascular response based upon a blinded retrospective histologic examination of the placenta and umbilical vessels (40 versus 12 percent) . In this study, mothers of infants with SIP were more likely to have received antibiotics before or at delivery (93 versus 57 percent).
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- Risk factors
- - Antenatal
- - Postnatal
- Exposure to glucocorticoids
- Exposure to indomethacin
- PATHOLOGY AND PATHOGENESIS
- CLINICAL MANIFESTATIONS
- Age at presentation
- Physical findings
- Associated infections
- Laboratory tests
- Surgical treatment
- - PPD technique
- SUMMARY AND RECOMMENDATIONS