SPONTANEOUS INTESTINAL PERFORATION IN PREMATURE-INFANTS - A DISTINCT CLINICAL ENTITY ASSOCIATED WITH SYSTEMIC CANDIDIASIS

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.