A role for neonatal bacteremia in deaths due to intestinal perforation: spontaneous intestinal perforation compared with perforated necrotizing enterocolitis



To examine the relationship between intestinal perforations (caused by either spontaneous perforation (SIP) or necrotizing enterocolitis (NEC)) and the outcome “death due to intestinal perforation”.


Multivariable logistic regression analyses were used to compare infants <28 weeks’ gestation with SIP (n = 32) and perforated-NEC (n = 45) for the outcome perforation-related death.


In univariate analyses the incidence of death due to perforation was higher among infants with perforated-NEC (36%) than infants with SIP (13%). However, infants with perforated-NEC were more likely to be older than 10 days and have bacteremia/fungemia with non-coagulase-negative staphylococci (non-CONS) organisms than infants with SIP. After adjusting for confounding the only variable that was significantly associated with mortality due to perforation was the presence of non-CONS bacteremia/fungemia at the onset of perforation.


The apparent association between death and perforated-NEC could be explained by the higher incidence of non-CONS bacteremia/fungemia among infants with perforated-NEC.

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Fig. 1: Relationship between the age of onset of the acute neonatal intestinal disease and the incidence of bacteremia/fungemia, SIP and perforated-NEC among infants with a perforated intestine (n = 77).

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.


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This work was supported by grant from the U.S. Public Health Service National Heart, Lung and Blood Institute (HL109199) and a gift from the Jamie and Bobby Gates Foundation.

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Correspondence to Ronald I. Clyman.

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We have no conflict of interests. None of the authors have any potential conflict of interest, real or perceived; None of the authors have any financial agreement with any company whose product figures prominently in the manuscript. There are no “sponsors” of this project. And there are no “sponsors” who have had a role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication. RIC wrote the first draft of the manuscript and no honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

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Clyman, R.I., Jin, C. & Hills, N.K. A role for neonatal bacteremia in deaths due to intestinal perforation: spontaneous intestinal perforation compared with perforated necrotizing enterocolitis. J Perinatol 40, 1662–1670 (2020). https://doi.org/10.1038/s41372-020-0691-4

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