Perforation of the gastrointestinal tract and peritonitis in the neonate.

A review of 60 neonates with perforation of the gastrointestinal tract and peritonitis was undertaken to evaluate efficacy of current treatment. Perforation was most frequently associated with necrotizing enterocolitis, spontaneous gastric perforation, intestinal obstruction and feeding tube perforation of the duodenum. Primary closure of proximal gastrointestinal tract perforations and resections with diversion for distal perforations were the commonly used operative procedures. Mortality was 33 per cent, with most deaths (80 per cent) a result of sepsis or its complications. Increased risk of mortality was associated with lower birth weight and lower weight for gestational age, males, initial serum pH less than 7.30, delay in surgical treatment and feeding tube perforation. Peritoneal cultures were dominated by aerobic and facultative organisms with only 21 per cent yielding mixed aerobic-anaerobic cultures. No anaerobes were retrieved from post-operative wound infections or abscesses, and only one of 22 positive blood cultures yielded an anaerobe. Antibiotic therapy included combinations of aminoglycoside beta-lactam antibiotics and clindamycin. Improving survival in this population, particularly in infants less than 1 kilogram birth weight, was demonstrated.