Prognostic Factors of Surgically Treated Pneumoperitoneum in Neonates

ABSTRACT

PURPOSE: This study aims to determine the prognostic factors of pneumoperitoneum in neonates. METHODS: We reviewed 35 neonates who underwent operations for pneumoperitoneum between 1999 and 2007. The prognostic factors on survival were evaluated. RESULTS: Twenty-eight patients were male and 7 were female. Mean gestational age was 35.9+/-4.6 weeks and birth weight was 2,703.1+/-999.2 gr. Mean apgar-score were 6.0+/-2.9 at 1 min, and 6.7+/-2.6 at 5 min. The most common clinical finding was abdominal distension. Most patients were diagnosed with a simple abdominal X-ray. Perforation sites were stomach (n=8), small bowel (n=20), colon (n=5), and small bowel and colon (n=2). Operative methods were bowel resection with enterostomy (n=15), resection with anastomosis (n=9), wedge resection (n=4), primary closure (n=3), primary closure with enterostomy (n=3), and penrose-drain insertion (n=1). Postoperative complications occurred in 16 patients, and 26 patients survived and 9 expired. Mortality rate was significantly higher in lesser gestational age, lower birth weight and apgar-score, need of preoperative ventilator, and abnormalities in ABGA or platelet count. CONCLUSION: The significant prognostic factors were gestational age, birth weight, Apgar-score, need of preoperative ventilator, and abnormal laboratory findings in ABGA and platelet count. The other variables including sex, symptom duration, underlying diseases, perforation sites, and operation methods were not correlated with survival.