title: Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation: a prospective 5-year multicenter analysis.
abstract: BACKGROUND
  Spontaneous intestinal perforation (SIP) has been recognized as a distinct disease entity. This study sought to quantify mortality associated with laparotomy-confirmed SIP and to compare it to mortality of laparotomy-confirmed necrotizing enterocolitis (NEC).
  
  
  METHODS
  Data were prospectively collected on 177,618 very-low-birth-weight (VLBW, 401-1500g) neonates born between January 2006 and December 2010 admitted to US hospitals participating in the Vermont Oxford Network (VON). SIP was defined at laparotomy as a focal perforation of the intestine without features suggestive of NEC or other intestinal abnormalities. The primary outcome was in-hospital mortality.
  
  
  RESULTS
  At laparotomy, 2036 (1.1%) neonates were diagnosed with SIP and 4076 (2.3%) with NEC. Neonates with laparotomy-confirmed SIP had higher mortality (19%) than infants without NEC or SIP (5%, P=0.003). However, laparotomy-confirmed SIP patients had significantly lower mortality than those with confirmed NEC (38%, P<0.0001). Mortality in both NEC and SIP groups decreased with increasing birth weight and mortality was significantly higher for NEC than SIP in each birth weight category. Indomethacin and steroid exposure were more frequent in the SIP cohort than the other two groups (P<0.001).
  
  
  CONCLUSIONS
  In VLBW infants, the presence of laparotomy-confirmed SIP increases mortality significantly. However, laparotomy-confirmed NEC mortality was double that of SIP. This relationship is evident regardless of birth weight. The variant mortality of laparotomy-confirmed SIP versus laparotomy-confirmed NEC highlights the importance of differentiating between these two diseases both for clinical and research purposes.
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Fisher
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Jones
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Gutierrez
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Hull
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA.
authors.forename: Kuang Horng
authors.initials: KH
authors.lastname: Kang
authors.affiliation: Vermont-Oxford Network, Burlington, VT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kenny
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
authors.affiliation: Vermont-Oxford Network, Burlington, VT, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Horbar
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, GA, USA. Electronic address: tom.jaksic@childrens.harvard.edu.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality* / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D012422:Rupture, Spontaneous; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Birth weight category; Focal intestinal perforation; Low birth weight; Necrotizing enterocolitis; Neonatal mortality; Spontaneous intestinal perforation