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Oh and Choi: Prognostic Factors of Surgically Treated Pneumoperitoneum in Neonates
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(2): 127-133.

Published online: 4 August 2009

DOI: https://doi.org/10.4174/jkss.2009.77.2.127

Prognostic Factors of Surgically Treated Pneumoperitoneum in Neonates

Bo-young Oh, M.D., Kum-ja Choi, M.D.

Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author (kumchoi@ewha.ac.kr)

Received 19 March 2009       Accepted 14 May 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

This study aims to determine the prognostic factors of pneumoperitoneum in neonates.

Methods

We reviewed 35 neonates who underwent operations for pneumoperitoneum between 1999 and 2007. The prognostic factors on survival were evaluated.

Results

Twenty-eight patients were male and 7 were female. Mean gestational age was 35.9±4.6 weeks and birth weight was 2,703.1±999.2 gr. Mean apgar-score were 6.0±2.9 at 1 min, and 6.7±2.6 at 5 min. The most common clinical finding was abdominal distension. Most patients were diagnosed with a simple abdominal X-ray. Perforation sites were stomach (n=8), small bowel (n=20), colon (n=5), and small bowel and colon (n=2). Operative methods were bowel resection with enterostomy (n=15), resection with anastomosis (n=9), wedge resection (n=4), primary closure (n=3), primary closure with enterostomy (n=3), and penrose-drain insertion (n=1). Postoperative complications occurred in 16 patients, and 26 patients survived and 9 expired. Mortality rate was significantly higher in lesser gestational age, lower birth weight and apgar-score, need of preoperative ventilator, and abnormalities in ABGA or platelet count.

Conclusion

The significant prognostic factors were gestational age, birth weight, Apgar-score, need of preoperative ventilator, and abnormal laboratory findings in ABGA and platelet count. The other variables including sex, symptom duration, underlying diseases, perforation sites, and operation methods were not correlated with survival.

Keywords: Pneumoperitoneum, Neonate, Mortality, Prognostic factor

Figures and Tables

Table 1
Demographic characteristics of patients
jkss-77-127-i001
Table 2
Clinical findings of patients
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*Symptom each have same number of cases separately.

Table 3
Associated diseases
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*Cleft lip, meningitis, neonatal convulsion, neonatal hyperbilirubinemia, small for gestational age, ostium secundum atrial septal defect secondum, pulmonary hemorrhage, biliary atresia, asplenia, extremely low birth weight, hyperthyroidism, intraventricular hemorrhage, coarctation of aorta.

Table 4
Causes of pneumoperitoneum
jkss-77-127-i004

*Pylorous 2, ileum 5, colon 3; †stomach 1, jejunum 1, ileum 3, colon 1; ‡stomach 1, ileum 2.

Table 5
Perforation site & operation method
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Table 6
Postoperative complications
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Table 7
Causes of death
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Table 8
Prognostic factors for survival
jkss-77-127-i008

*ABGA = arterial blood gas analysis; †Hb = hemoglobin; ‡WBC = white blood cell; §PLT = platelet; ∥CRP = C reactive protein.

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