Management of neonatal spontaneous intestinal perforation by peritoneal needle aspiration

• Published in: Journal of perinatology Vol. 38; no. 2; pp. 159 - 163
• Main Authors: Gébus, M, Michel, J-L, Samperiz, S, Harper, L, Alessandri, J-L, Ramful, D
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-02-2018; Nature Publishing Group
• Subjects: 692/699/1503/1581; 692/700/565/2194; Abdomen; Antibiotics; Birth weight; Care and treatment; Children; Cholestasis; Enteral feeding; Enteral nutrition; Gallbladder diseases; Gestational age; Health aspects; Hospitals; Hypotension; Infants; Intestinal perforation; Intestine; Laparotomy; Lesions; Medicine; Medicine & Public Health; Menstruation; Morbidity; Needle biopsy; Neonates; Newborn babies; Nonsteroidal anti-inflammatory drugs; Nutrition; original-article; Patient outcomes; Patients; Pediatric Surgery; Pediatrics; Perforation; Peritoneum; Postpartum period; Premature infants; Sepsis; Stricture
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2017.170

Objective:
To describe conservative management of spontaneous intestinal perforation (SIP) in preterm infants using peritoneal needle aspiration (PNA).
Study design:
Monocentric retrospective review of SIP cases treated primarily by PNA between 1999 and 2015 (
n
=31).
Results:
Mean gestational age was 29.2±2.4 weeks and birthweight 1149±428 g. SIP occurred at 3.7±2.2 days of life. PNA achieved definitive treatment in 18 patients (60%) with a mean of 1.8 (±0.8) procedures. All patients requiring more than three PNAs had secondary laparotomy. Two patients died and five presented severe cerebral lesions. Full enteral feeding was achieved 42±18 days after SIP. Intestinal morbidity included cholestasis (
n
=6), intestinal stricture (
n
=1) and growth restriction (
n
=22). On follow-up (
n
=25, median=4 years), no severe impairment was noted. Seventeen children (68%) had a normal development.
Conclusion:
PNA as primary therapy for SIP is a viable option, resulting in definitive treatment in 60% of cases, with limited mortality and morbidity.