Kuremu R T, Hadley G P, Wiersma R
Department of Surgery, Faculty of Health Sciences, Moi University, PO Box 4606, Eldoret, Kenya.
East Afr Med J. 2003 Sep;80(9):452-5. doi: 10.4314/eamj.v80i9.8741.
Gastro-intestinal tract (GIT) perforation in neonates is a serious problem associated with high mortality due to resulting sepsis. Co-morbid factors, eg. prematurity, respiratory problems, low birth weight, and nutritional factors, negatively affect the outcome.
To review the management outcome of gastro-intestinal tract perforation in neonates in KwaZulu-Natal and identify factors that require attention for better survival of neonates with GIT perforation.
Retrospective study of consecutive complete data sets of patients presenting with a diagnosis of GIT perforation.
Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa.
Fifty four neonates treated for gastro-intestinal tract perforation between January 1998 and January 2003.
Morbidity as determined by complications and mortality.
More males (69%) were affected than females (31%). The median birth weight was 2.3 kg and median age at presentation was four days. Eighty nine percent were referred from peripheral hospitals. Abdominal distension was the leading symptom and sign (74%). Co-morbid factors were present in 89%, with prematurity as the leading factor (52%). Necrotising enterocolitis (NEC) was the main cause of perforation (33%) and the terminal ileum was the most common site. Most (56%) were treated by excision and primary repair of perforations. Sepsis was the leading complication (44%) and major cause of death (72%). Mortality was highest (56%) in perforations due to other primary pathology followed by NEC (53%). Overall mortality was 46%.
It is essential to prevent secondary perforations by early recognition and management of primary pathology. Management of pneumoperitoneum in neonates with respiratory difficulties should be included in resuscitation before transfer. Rectal temperature monitoring and herbal enemas should be strongly discouraged.
新生儿胃肠道穿孔是一个严重问题，因引发败血症而导致高死亡率。合并症因素，如早产、呼吸问题、低出生体重和营养因素，会对预后产生负面影响。
回顾夸祖鲁 - 纳塔尔省新生儿胃肠道穿孔的治疗结果，并确定为提高胃肠道穿孔新生儿的存活率而需要关注的因素。
对诊断为胃肠道穿孔患者的连续完整数据集进行回顾性研究。
南非德班纳塔尔大学纳尔逊·曼德拉医学院儿外科。
1998年1月至2003年1月期间接受胃肠道穿孔治疗的54例新生儿。
由并发症和死亡率确定的发病率。
男性受影响者（69%）多于女性（31%）。中位出生体重为2.3千克，就诊时的中位年龄为4天。89% 的患儿是从周边医院转诊而来。腹胀是主要症状和体征（74%）。89% 的患儿存在合并症因素，其中早产是主要因素（52%）。坏死性小肠结肠炎（NEC）是穿孔的主要原因（33%），最常见的穿孔部位是回肠末端。大多数（56%）患儿接受了穿孔切除及一期修复治疗。败血症是主要并发症（44%）和主要死亡原因（72%）。因其他原发性病理导致的穿孔死亡率最高（56%），其次是NEC（53%）。总体死亡率为46%。
通过早期识别和处理原发性病理来预防继发性穿孔至关重要。对于有呼吸困难的新生儿，在转运前的复苏过程中应包括对气腹的处理。应强烈不建议进行直肠温度监测和草药灌肠。
