Gastro-intestinal tract perforation in neonates.
BACKGROUND
Gastro-intestinal tract (GIT) perforation in neonates is a serious problem associated with high mortality due to resulting sepsis. Co-morbid factors, eg. prematurity, respiratory problems, low birth weight, and nutritional factors, negatively affect the outcome.


OBJECTIVE
To review the management outcome of gastro-intestinal tract perforation in neonates in KwaZulu-Natal and identify factors that require attention for better survival of neonates with GIT perforation.


METHODS
Retrospective study of consecutive complete data sets of patients presenting with a diagnosis of GIT perforation.


METHODS
Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa.


METHODS
Fifty four neonates treated for gastro-intestinal tract perforation between January 1998 and January 2003.


METHODS
Morbidity as determined by complications and mortality.


RESULTS
More males (69%) were affected than females (31%). The median birth weight was 2.3 kg and median age at presentation was four days. Eighty nine percent were referred from peripheral hospitals. Abdominal distension was the leading symptom and sign (74%). Co-morbid factors were present in 89%, with prematurity as the leading factor (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 excision and primary repair of perforations. Sepsis was the leading complication (44%) and major cause of death (72%). Mortality was highest (56%) in perforations due to other primary pathology followed by NEC (53%). Overall mortality was 46%.


CONCLUSIONS
It is essential to prevent secondary perforations by early recognition and management of primary pathology. Management of pneumoperitoneum in neonates with respiratory difficulties should be included in resuscitation before transfer. Rectal temperature monitoring and herbal enemas should be strongly discouraged.
Kuremu
R T
RT
Department of Surgery, Faculty of Health Sciences, Moi University, PO Box 4606, Eldoret, Kenya.
Hadley
G P
GP
Wiersma
R
R
D000890:Anti-Infective Agents / Q000627:therapeutic use; D001724:Birth Weight; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate
D000890:Anti-Infective Agents