Spontaneous Intestinal Perforation (SIP) is a condition seen with some frequency in premature neonates.
Patient selection: neonate born <= 28 weeks of gestation (rarely later)
Risk factors that have been proposed:
(1) multiple fetuses (twins, triplets, etc)
(2) gestational age < 25 weeks
(3) low birthweight (typically < 1,000 grams)
(4) indomethacin before or after delivery
(5) postnatal hydrocortisone
(6) antenatal magnesium
(7) birthweight loss > 10%
(8) fetal hypoxia
Features:
(1) acquired condition not due to trauma or other apparent cause
(2) one or more perforations in the intestines, most often in the terminal ileum but also in jejunum or colon
It tends to occur at a mean age of 7 days.
There is black-bluish discoloration of the abdomen. The patient may have abdominal distention with vomiting.
Ultrasound or other imaging method often demonstrate pneumoperitoneum.
Differential diagnosis:
(1) necrotizing enterocolitis
(2) trauma
(3) enteritis
