SPONTANEOUS GASTROINTESTINAL PERFORATION IN VERY-LOW-BIRTH-WEIGHT INFANTS - A RARE COMPLICATION IN A NEONATAL INTENSIVE-CARE UNIT

Over a 6-year period (1989-1995), gastrointestinal (GI) perforation wa s diagnosed in nine preterm infants (mean gestional age 27 weeks, mean birth weight 872 g). Three presented with necrotizing enterocolitis ( NEC), two with indwelling-tube-induced perforation of the stomach, one with small-left-colon syndrome, and another with meconium ileus. Spon taneous intestinal perforation occurred in two; similar very-low-birth -weight (VLBW) infants, in the distal ileum, on days 8 and 9 of life, respectively. The only clinical sign was extensive abdominal distensio n, and abdominal X-ray studies revealed free peritoneal air. All findi ngs were distinct from those associated with NEC. Their further clinic al course was complicated by reperforation on day 32 and 39, respectiv ely. They subsequently recovered and presented without CI problems at the corrected ages of 4 and 2 months, respectively. In contrast to hig h mortality of 57% in the group with non-spontaneous intestinal perfor ations, spontaneous perforation seems to have a good prognosis even in VLBW infants if diagnosed and treated promptly.