Gastrointestinal Perforation in Neonates: Aetiology and Risk Factors
PURPOSE Peritoneal drainage (PD) constitutes a definitive therapy for a subset of extremely low birth weight (ELBW) infants with spontaneous intestinal perforation (SIP). We investigated the factors which may differentiate these patients from those who require a laparotomy (LAP) after initial PD. METHODS A retrospective chart review of all ELBW infants (<1000 grams) who underwent PD at two tertiary neonatal intensive care units over a 42-month period was performed. Demographic, clinical, laboratory, and radiological data of the entire patient cohort were collected. Patients who underwent definitive PD were compared to those who required LAP following PD. Statistical comparisons were performed using independent samples T-tests for continuous variables, and Fisher's exact test for categorical variables. RESULTS Sixteen ELBW infants with SIP underwent PD. Five patients (31%) had definitive PD and 11 (69%) subsequently required LAP. Patients who had definitive PD had a lower percent band count at diagnosis (3.2+/-1.5 vs. 18.0+/-4.8; p=0.01), and were less likely to require vasopressor therapy at diagnosis and drain placement (40% vs. 91%, p=0.06), 24 hours later (40% vs. 100%, p=0.02), and 48 hours later (20% vs. 91%, p=0.01). There were no other statistically significant differences in any of the measured variables. Survival to discharge was 80% for PD and 82% for LAP (p=1.0). CONCLUSION Peritoneal drainage for spontaneous intestinal perforation in ELBW neonates is more likely to be definitive in the absence of bandemia and vasopressor requirement. These may be important factors in deciding whether to proceed to laparotomy.