From the Guidelines
Sudden intestinal perforation in neonates is most commonly caused by necrotizing enterocolitis, spontaneous intestinal perforation, meconium ileus, and iatrogenic injury, as supported by the evidence from 1. The management of sudden intestinal perforation in neonates requires a multidisciplinary approach, including immediate surgical intervention and supportive care. When a neonate presents with sudden abdominal distension, respiratory distress, lethargy, feeding intolerance, or bilious vomiting, perforation should be suspected. Initial management includes:
- Fluid resuscitation with 10-20 ml/kg of normal saline or lactated Ringer's solution
- Broad-spectrum antibiotics, such as ampicillin, gentamicin, and metronidazole, as recommended by 1 and 1
- Nasogastric decompression
- Respiratory support as needed Obtain immediate abdominal X-rays to confirm the diagnosis, which typically show pneumoperitoneum (free air). Laboratory tests should include:
- Complete blood count
- Electrolytes
- Blood cultures
- Coagulation studies Surgical exploration is necessary to repair the perforation, with options including primary repair, resection with anastomosis, or temporary ostomy creation depending on the extent of damage and the neonate's condition. Postoperatively, continue antibiotics for 7-10 days, provide parenteral nutrition until bowel function returns, and monitor closely for complications such as sepsis, short bowel syndrome, or stricture formation. The use of probiotics, such as Lactobacillus spp and Bifidobacterium spp, may be beneficial in preventing necrotizing enterocolitis in preterm infants, as suggested by 1. Early recognition and prompt intervention are critical for improving survival rates and reducing long-term complications in these fragile patients.
From the Research
Causes of Sudden Intestinal Perforation in Neonates
- Necrotizing enterocolitis (NEC) is a major cause of intestinal perforation in neonates, particularly in premature infants 2, 3
- Prematurity, low birth weight, and respiratory problems are co-morbid factors that can contribute to the development of intestinal perforation in neonates 3
- Other potential causes of intestinal perforation in neonates include spontaneous gastric perforation, although the exact etiology is often unclear 4
- The terminal ileum is a common site for intestinal perforation in neonates 3
Risk Factors
- Premature birth is a significant risk factor for developing NEC and subsequent intestinal perforation 2, 3
- Low birth weight and respiratory problems can also increase the risk of intestinal perforation in neonates 3
- The use of herbal enemas and rectal temperature monitoring can increase the risk of intestinal perforation in neonates 3