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Delayed diagnosis of spontaneous intestinal perforation among very low birth weight neonates: A single center experience

Journal of Perinatology volume 39, pages 1509–1520 (2019)Cite this article

Subjects

Abstract

Objective

To assess incidence and effect of delayed diagnosis of spontaneous intestinal perforation (SIP).

Study design

Retrospective case series review of 58 VLBW neonates with SIP at our institution.

Result

SIP was diagnosed in 6.1%, 10%, and 15.1% of VLBW, ELBW, and ≤750 g neonates, respectively. Abdominal distension (58.6%) and abdominal discoloration (53.4%) were the most common presenting signs/symptoms. Smaller (≤750 g) neonates were more likely to present with hypotension and higher FiO2, and larger (751–1500 g) neonates with increased abdominal girth and abdominal distension. All but one neonate had radiographic pneumoperitoneum, and 25.9% had pneumoperitoneum on an X-ray prior to the X-ray at SIP diagnosis. An education module reduced delay in SIP diagnosis.

Conclusion

SIP presentation varies by birth weight and gestational age. Since SIP diagnosis is often first suggested on X-ray, all X-rays of VLBW neonates in the first 2 weeks of life should be scrutinized for pneumoperitoneum.

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Authors and Affiliations

  1. Division of Neonatology, Joe DiMaggio Children’s Hospital, Hollywood, FL, USA

    Doron J. Kahn & Sandra Gregorisch

  2. Envision Healthcare, Plantation, FL, USA

    Doron J. Kahn & Paul D. Fisher

  3. Division of Pediatric Surgery, Joe DiMaggio Children’s Hospital, Hollywood, FL, USA

    Jill S. Whitehouse

  4. Division of Pediatric Radiology, Joe DiMaggio Children’s Hospital, Hollywood, FL, USA

    Paul D. Fisher

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  1. Doron J. Kahn
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  2. Sandra Gregorisch
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  3. Jill S. Whitehouse
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  4. Paul D. Fisher
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Contributions

DJK collected and analyzed the data, drafted the initial paper, and approved the final paper. SG, RN (and neonatal nurse practitioner in training), collected and analyzed the data, helped draft the initial paper, and approved the final paper. JSW analyzed the data, revised the paper, and approved the final paper. PDF analyzed the data, revised the paper, and approved the final paper.

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Correspondence to Doron J. Kahn.

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Kahn, D.J., Gregorisch, S., Whitehouse, J.S. et al. Delayed diagnosis of spontaneous intestinal perforation among very low birth weight neonates: A single center experience. J Perinatol 39, 1509–1520 (2019). https://doi.org/10.1038/s41372-019-0480-0

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