Delayed diagnosis of spontaneous intestinal perforation among very low birth weight neonates: A single center experience

Objective To assess incidence and effect of delayed diagnosis of spontaneous intestinal perforation (SIP). Study design Retrospective case series review of 58 VLBW neonates with SIP at our institution. Result SIP was diagnosed in 6.1%, 10%, and 15.1% of VLBW, ELBW, and <= 750 g neonates, respectively. Abdominal distension (58.6%) and abdominal discoloration (53.4%) were the most common presenting signs/symptoms. Smaller (<= 750 g) neonates were more likely to present with hypotension and higher FiO2, and larger (751-1500 g) neonates with increased abdominal girth and abdominal distension. All but one neonate had radiographic pneumoperitoneum, and 25.9% had pneumoperitoneum on an X-ray prior to the X-ray at SIP diagnosis. An education module reduced delay in SIP diagnosis. Conclusion SIP presentation varies by birth weight and gestational age. Since SIP diagnosis is often first suggested on X-ray, all X-rays of VLBW neonates in the first 2 weeks of life should be scrutinized for pneumoperitoneum.