GASTRO-INTESTINAL TRACT PERFORATION IN NEONATES

ABSTRACTBackground: Gastro-intestinal tract (GIT) perforation in neonates is a serious problemassociated with high mortality due to resulting sepsis. Co-morbid factors, eg. prematurity,respiratory problems, low birth weight, and nutritional factors, negatively affect theoutcome.Objectives: To review the management outcome of gastro-intestinal tract perforation inneonates in KwaZulu-Natal and identify factors that require attention for better survivalof neonates with GIT perforation.Design: Retrospective study of consecutive complete data sets of patients presenting witha diagnosis of GIT perforation.Setting: Department of Paediatric Surgery, Nelson R. Mandela School of Medicine,University of Natal, Durban, South Africa.Subjects: Fifty four neonates treated for gastro-intestinal tract perforation betweenJanuary 1998 and January 2003.Main outcome measures: Morbidity as determined by complications and mortality.Results: More males (69%) were affected than females (31%). The median birth weightwas 2.3 kg and median age at presentation was four days. Eighty nine percent werereferred from peripheral hospitals. Abdominal distension was the leading symptom andsign (74%). Co-morbid factors were present in 89%, with prematurity as the leadingfactor (52%). Necrotising enterocolitis (NEC) was the main cause of perforation (33%)and the terminal ileum was the most common site. Most (56%) were treated by excisionand primary repair of perforations. Sepsis was the leading complication (44%) and majorcause of death (72%). Mortality was highest (56%) in perforations due to other primarypathology followed by NEC (53%). Overall mortality was 46%.Conclusion: It is essential to prevent secondary perforations by early recognition andmanagement of primary pathology. Management of pneumoperitoneum in neonates withrespiratory difficulties should be included in resuscitation before transfer. Rectaltemperature monitoring and herbal enemas should be strongly discouraged