Open AccessGastrointestinal Perforation in Neonates: Aetiology and Risk Factors
Author(s) -
Hyginus Okechukwu Ekwunife,
Ugwu Jideoffor,
Modekwe Victor,
Osuigwe Andrew N
Publication year - 2013
Publication title -
journal of neonatal surgery
Language(s) - English
Resource type - Journals
ISSN - 2226-0439
DOI - 10.47338/jns.v2.42
Subject(s) - medicine , necrotizing enterocolitis , exploratory laparotomy , perforation , anastomosis , laparotomy , gastrointestinal perforation , surgery , sepsis , colostomy , ileostomy , etiology , pediatrics , peritonitis , materials science , punching , metallurgy
Background: Gastrointestinal perforation (GIP) in neonates presents important challenges and mortality can be high. This is a report of recent experience with GIP in neonates in a developing country.Patients and methods: A retrospective review of 16 neonates treated for GIP in a 3 year period.Results: There were 9 males and 7 females, aged 0-28 days (median age =7days). Their weights at presentation ranged from 0.9 - 4.7kg (median =2.6). Five infants were premature. Twelve infants presented more than 72 hours after onset of symptoms. Plain abdominal radiographs showed peumoperitoneum in 9 infants. The cause of perforation was necrotising enterocolitis 6, intestinal obstruction 6, iatrogenic 3 and spontaneous 1. The site of perforation was ileum in 12 infants, stomach in 4 and colon in 4; 4 patients had involvement of more than one site. All the neonates underwent exploratory laparotomy with primary closure ( n=5) , resection and anastomosis( n=6), colostomy (n=3), Ileostomy ( n=2), partial gastrectomy (n=2) ,or gastrojejunostomy ( n=1). Two neonates had multiple procedures. Two very sick preterm babies had an initial peritoneal lavage. Surgical site infection is the commonest postoperative complication occurring in 9 infants. Anaesthesia sepsis and malnutrition is responsible for the seven deaths recorded.Conclusions: Neonatal GIP has multiple aetiologies; NEC is the most common cause. Major mortality risk factors include NEC, multiple perforations, delayed presentation and prematurity.