Ee. Adderson et al., SPONTANEOUS INTESTINAL PERFORATION IN PREMATURE-INFANTS - A DISTINCT CLINICAL ENTITY ASSOCIATED WITH SYSTEMIC CANDIDIASIS, Journal of pediatric surgery, 33(10), 1998, pp. 1463-1467
Purpose:The aim of this study was to define patient characteristics, r
isk factors, microbiology, and outcome of spontaneous intestinal perfo
rations (SIP) in premature infants. Methods: To identify the character
istics and frequency of SIP, the medical records of 94 premature infan
ts were reviewed retrospectively. Results: Eleven infants experienced
12 episodes of SIP and 53 infants had 55 episodes of confirmed necroti
zing enterocolitis (NEC). Compared with infants who had NEC, the infan
ts with SIP were smaller and born more prematurely. The onset of illne
ss was earlier and was associated with antecedent hypotension, leukocy
tosis, and a gasless appearance on abdominal radiograph. Blue abdomina
l discoloration was present in 11 of 12 babies with SIP, but in only o
ne of the babies with NEC. Infants with SIP were significantly more li
kely to have systemic candidiasis. When controlling for birth weight a
nd age, early onset, blue abdomen, and a gasless abdominal radiograph
continued to be statistically significant markers of SIP. Conclusions:
SIP occurs about 12-fold less frequently than NEC in preterm infants.
A combination of clinical, laboratory, and radiological features dist
inguish very low birthweight infants with SIP from those with NEC. Obv
ious signs of bowel perforation are infrequent with SIP. SIP is freque
ntly associated with systemic candidiasis. Copyright (C) 1998 by W.B.
Saunders Company.