Adderson E E, Pappin A, Pavia A T
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA.
J Pediatr Surg. 1998 Oct;33(10):1463-7. doi: 10.1016/s0022-3468(98)90475-4.
The aim of this study was to define patient characteristics, risk factors, microbiology, and outcome of spontaneous intestinal perforations (SIP) in premature infants.
To identify the characteristics and frequency of SIP, the medical records of 94 premature infants were reviewed retrospectively.
Eleven infants experienced 12 episodes of SIP and 53 infants had 55 episodes of confirmed necrotizing enterocolitis (NEC). Compared with infants who had NEC, the infants with SIP were smaller and born more prematurely. The onset of illness was earlier and was associated with antecedent hypotension, leukocytosis, and a gasless appearance on abdominal radiograph. Blue abdominal discoloration was present in 11 of 12 babies with SIP, but in only one of the babies with NEC. Infants with SIP were significantly more likely to have systemic candidiasis. When controlling for birth weight and age, early onset, blue abdomen, and a gasless abdominal radiograph continued to be statistically significant markers of SIP.
SIP occurs about 12-fold less frequently than NEC in preterm infants. A combination of clinical, laboratory, and radiological features distinguish very low birthweight infants with SIP from those with NEC. Obvious signs of bowel perforation are infrequent with SIP. SIP is frequently associated with systemic candidiasis.
本研究旨在明确早产儿自发性肠穿孔（SIP）的患者特征、危险因素、微生物学情况及预后。
为确定SIP的特征和发生率，对94例早产儿的病历进行回顾性分析。
11例婴儿发生了12次SIP，53例婴儿发生了55次确诊的坏死性小肠结肠炎（NEC）。与患NEC的婴儿相比，患SIP的婴儿体型更小，早产程度更高。发病更早，且与前期低血压、白细胞增多及腹部X线平片上无气表现有关。12例患SIP的婴儿中有11例出现腹部皮肤发蓝，但患NEC的婴儿中只有1例出现。患SIP的婴儿发生全身性念珠菌病的可能性显著更高。在控制出生体重和年龄后，发病早、腹部皮肤发蓝及腹部X线平片无气仍然是SIP的统计学显著标志。
早产儿中SIP的发生率约为NEC的1/12。临床、实验室和放射学特征相结合可将患SIP的极低出生体重儿与患NEC的患儿区分开来。SIP很少出现明显的肠穿孔体征。SIP常与全身性念珠菌病相关。
