A Comparison of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation in Preterm infant

ABSTRACT

PURPOSE: Besides necrotizing enterocolitis (NEC), the most common cause of intestinal perforation in preterm infants, there is another condition called spontaneous intestinal perforation (SIP) which, though it does not have the clinical or histological nature of NEC has been reported with increasing tendency. Aims of this study are to analyze gastrointestinal perforation in preterm infants and to speculate any difference in clinical manifestations, perinatal histories, and laboratory results between NEC and SIP. METHODS: A retrospective review of medical records of preterm infants with gastrointestinal perforations in the neonatal intensive care unit of Seoul National University Children's Hospital between January 2000 and August 2007 was performed. Preterm infants who underwent surgical intervention, and who had available histologic specimens, were enrolled. RESULTS: A total of 29 preterm infants were enrolled. They were classified into three groups Group NEC (n=18), Group SIP (n=6), and Group Others (n=5). Group Others consisted of two patients with ileal atresia, one with meconeum ileus, one with omphalocele and one with anal atresia. Onset of perforation was delayed in Group NEC compared with that of Group SIP (18.1+/-13.0 versus 6.7+/-4.2; P<0.05) and enteral feeding before perforation was more frequent in Group NEC (94.4% versus 50%; P<0.05). CONCLUSION: During seven years and eight months, there were six cases of SIP and 18 cases of NEC in preterm infants. As well as NEC, SIP should be considered when gastrointestinal perforation is suspected, especially when patients with early onset time and no enteral feeding.