Clinical comparison of localized intestinal perforation and necrotizing enterocolitis in neonates.

OBJECTIVE: To better define the prognosis of neonates with gastrointestinal perforation and improve their management.
METHODS: We reviewed the results of physical examinations, laboratory results, and radiographic tests of 42 patients in whom gastrointestinal perforation was diagnosed in our neonatal intensive care unit.
RESULTS: Twenty-one patients had necrotizing enterocolitis and 21 had localized intestinal perforation. Perinatal history, gender, race, birth weight, and estimated gestational age were similar for both groups. Patients with localized perforation were more likely to have had an umbilical artery catheter in place within 48 hours of perforation, to have received higher doses of indomethacin, to have undergone primary surgical repair, and to have survived until discharge from the hospital. Patients with necrotizing enterocolitis were more likely to have received enteral feedings and to have had a metabolic acidosis and leukopenia at the time the perforation was diagnosed.
CONCLUSIONS: We conclude that localized intestinal perforation and necrotizing enterocolitis, although similar in the organ system they affect, are distinctly different in clinical correlates and outcome. The increased awareness of localized perforations may help those taking care of neonates to diagnose this condition more accurately and to discuss its implications with family members.