Spontaneous idiopatic intestinal perforation (SIPI): A distinct clinical entity in the preterm infant

Background: The most common cause of intestinal perforation in newborns is neerotizing enterocclytis (NEC). A novel condition has been increasingly deseribed of idiopathic spontaneous intestinal perforation (SIPI), which does not show tbe typical clinical and diagnostic features of NEC. The aim of the present study is to define clinical peculiarities and potential risk factors in newborns by comparing SIPI and NEC patients. Methods: In the last 4 years 85 preterm infants necessitated surgical counselling for acute abdominal conditions. Among them, 13 underwent emergency surgery, 6 for SIPI and 7 far NEC respectively. Patients were then subdivided into 3 groups: Group O, 72 infants, who did not need surgery; Group I,6 patients with SIPI; Group II 7 paLients with NEC. Some variables were retrospectively analyzed and were compared by means of CHI 2 test with a significative value of p<0.05. Results: No association emergerd between patient's sex gender (p=0.691), membrane ruptures (p=0.400) and maternal ìnfection (p=0.415). A correlation was observed between pneumoperitoneum and SIPI/NEC (p=0.000). The study on Group l and II showes a lower gestational age (27.3 as compared to 30_28 weeks) a higher number of membrane ruptures (4/6 as compared (O 3n) and of matemal infections (4/6 as compared to 3n). Comparative analysis showed that patients under 28 weeks of gestetional age have a 17 folds higher risk of SIPI (96%, p=0.001) as compared to patients with older gesrational age. Conclusions: Our study shows that a determining factor for the etiopatbogenesis of SIPI may be neonatal stress consequent to preterm birth. Infants under 28 weeks of gestational age, with low birth weight < 1.200 g) show a particular predisposition to SIPI, with a risk accounting te 96% of our case series.