A case series of iatrogenic gastrointestinal perforations in premature infants below 30 weeks' gestation

Background: Iatrogenic gastrointestinal perforations (IGP) in preterm newborns are rare, but life-threatening events. This report describes a case series of IGP who were admitted to one of the largest Neonatal Intensive Care Units (NICU) in the Netherlands. The aim of the study was to report on incidence, clinical presentation, mortality and long-term outcome. Method: Premature newborns below 30 weeks’ gestation who were admitted to a level IV NICU over a 5-year period (2018–2022), were included in this study. The diagnosis IGP was based on the complication registry in the electronic medical records, and was retrospectively reviewed. Results: The incidence of IGP in premature newborns below 30 weeks’ gestation was 1.8 %. Cases (n = 7) had a median birth weight of 700 g (range 595–1300 g). Causes of IGP were related to a nasogastric tube use (n = 4) or to lower gastrointestinal tract lesions as a result of enemas for delayed meconium passage (n = 3). IGP were located in the esophagus (1), stomach (1), duodenum (2), sigmoid (1) and rectum (2). Patients with IGP presented with sepsis-like symptoms (n = 4) or as an unexpected finding on radiological imaging. Five neonates underwent laparotomy, and the overall mortality was 57 % (n = 4) with 3 deaths related to sequelae from extreme prematurity. Long-term follow-up (n = 3) showed generally favorable outcome at 2 years of age. Conclusions: IGP is a rarely reported iatrogenic complication in preterm infants. We report an incidence of 1.8 % in preterm infants below 30 weeks’ gestation. Healthcare providers must be aware of this serious event, associated with high mortality rates. Levels of evidence: Level IV.