The Turkish Journal of Pediatrics
2009 , Vol 51 , Num 3
Neonatal gastrointestinal perforation
Division of Thoracic, Endocrine and Pediatric Surgery1,Department of Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan2,
Infants, especially extremely low birth weight infants (ELBWIs, birth weight
<1,000 g) continue to have a high mortality after gastrointestinal (GI)
perforation. In Japan, the overall mortality rate for neonates under 30 days
having GI perforation was 31.6% in 20031. From 1974 to 2003, 34 cases of GI
perforation in neonates were treated surgically in Fukuoka University Hospital.
The overall mortality rate was 50% (17 of 34). Etiologies included necrotizing
enterocolitis (NEC) (35.3%), meconium peritonitis (25%), idiopathic (25%),
and gastric perforation (11.8%). The present series was divided into four
groups: survival and non-survival neonates of the early (1974 to 1997) and
recent (1998 to 2004) periods. Several prognostic factors of neonatal GI
perforation were compared between several groups. The gestational week
(GW) at birth, birth weight (BW) and weight at operation were significantly
lower for non-surviving neonates in the recent period compared with the
other three groups. Although a real improvement in surgical outcome was
noted with improved neonatal intensive care management, the mortality rate
was still high, especially in extremely premature cases under both 1,000 g
and 29 GWs. The vast majority of these extremely premature babies thus
comprised the NEC patients. It is therefore necessary to substantially improve
the medical treatment level for such premature babies.
Keywords :
gastrointestinal perforation, necrotizing enterocolitis, low birth weight infant.