【Objective】 To explore the early clinical diagnosis of gastrointestinal perforation in preterm neonates. 【Methods】 Ten cases of premature gastrointestinal perforation were registered in five years.Based on their general conditions,the incidence time,early clinical manifestation,diagnostic methods and prognosis of gastrointestinal perforation and possible precipitating factor of perforation,the early clinical diagnosis of gastrointestinal perforation in preterm neonates were analyzed. 【Results】 1)Totally,there were ten cases (6 males) with the average gestational age of 32 weeks,average body weight of 1 555 g,which included five small gestational age (SGA) perterms and 7 babies were one of the twin infants (7/10).2)Perforation occurred during 9 hours to 70 hours after birth (average=26 hours).The first clinical symptoms of the perforation were vomiting and abdominal distension;typical clinical manifestation appearance time was from 18 hours to 96 hours after birth (average=48 hours).The typical clinical manifestations included abdominal distension,high tension,abdominal wall pallidness,bowel sounds disappearence.The abdominal orthostatic X-ray images showed a great quantity of free gas under the flat diaphragm,declined liver bound,and abdominal paracentesis in some cases.Two cases were with good post-surgical outcomes and 7 cases died (mortality=7/9);1 case was lost of following-up.3)Induce factors of the gastrointestinal perforation:infection followed by gastrointestinal perforation (2/10);spontaneous gastrointestinal perforation (8/10);gastrointestinal perforation followed by infection (6/8).Six cases began to feed before onset symptoms appeared.Five cases had noninvasive ventilator before gastrointestinal perforation (5/10). 【Conclusions】 Small gestational age and low birth weight are high-risk factors of the gastrointestinal perforation.One to two days after birth and during severe infection is the high-risk occurrence time.Vomiting and/or abdominal distension are the first clinical symptoms in premature infants with perforation.Congenital poor growth in digestive tract is the foundation of perforation in premature infants.Infection,feeding and noninvasive ventilation may be precipitating factors.Once above-mentioned conditions appear in premature infants,we should be precautious about the gastrointestinal perforation in clinic.
Key words
preterm neonate /
gastrointestinal perforation /
early diagnosis
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