NEONATAL PERFORATIONS OF THE GASTROINTESTINAL-TRACT

Objective: Neonatal gastrointestinal perforations continue to be assoc iated with high mortality. The causes of such perforations are diverse and knowledge of such causes is of great importance for successful ma nagement. This report is based on our experience of 40 infants with ga strointestinal perforations outlining the causes and analyzing factors relevant to outcome. Methods: The medical records of all neonates wit h gastrointestinal perforations were retrospectively reviewed, Qatif C entral Hospital. Results: Forty infants (24 females and 16 males) were analyzed. Their birth weight ranged from 700 grams to 3200 grams (mea n 1800 grams). Perforations occurred from birth to 56 days (mean 10.4 days). Necrotizing enterocolitis (NEC) was the most common causes. Oth er causes included intrauterine volvolus,(2) total colonic Hirschsprun g's disease,(1) meconium ileus,(1) aminophyline therapy,(1) focal abse nce of small bowel.(1) There were 15 perforations in the small intesti ne, 6 in the large bowel, 4 in the stomach and 4 in the duodenum. Twen ty six (65%) died, 11 of whom had extensive necrotizing enterocolitis. Prematurity, low birth weight, and septicemia including candida septi cemia are other contributing factors to mortality. Conclusion: Necroti zing enterocolitis continues to be the most common cause of neonatal p erforations but awareness of the different causes is a pre requisite t o proper management. Extensive involvement of the bowel by NEC was res ponsible for the majority of deaths. Fungal sepsis is a newly recogniz ed cause of morbidity and mortality in these patients. Simple closure for isolated perforations or resection and immediate reconstruction of bowel continuity is the best form of treatment but circumstances may warrant creation of stoma in some instances.