Risk Factors for Spontaneous Intestinal Perforation in Extremely Low Birth Weight Infants§

Irfan Ahmad1, Kristy F. Davis2, Sherif Emi2, *, Cherry Uy1, Jack Sills1
1 Division of Neonatology, Department of Pediatrics
2 Division of Pediatric Surgery, Department of Surgery University of California Irvine School of Medicine and Children’s Hospital, USA

© 2008 Ahmad et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Division of Pediatric Surgery, University of California, Irvine Medical Center, 101 The City Dr., Bldg 55, Room 110, Rte 81, Orange, CA 92868-3298; USA; Tel: (714) 456 8581; Fax: (714) 456 8931; E-mail:



Spontaneous intestinal perforations (SIP) in extremely low birth weight infants are distinctly different from necrotizing enterocolitis. The etiology of SIP is not well understood. Our objective was to identify perinatal therapeutic interventions that may increase the risk of spontaneous intestinal perforations.


Medical records of extremely low birth weight infants (BW<1000g) admitted to a neonatal intensive care unit during 42-month period were studied. Infants with radiologic or histologic diagnosis of necrotizing enterocolitis were excluded. Information collected included maternal and infant demographics, perinatal risk factors, clinical findings and interventions, and exposure to medications before and after delivery. Chi square and paired t-tests were used to compare SIP patients to those with no perforation (NP). Mean values are given with standard error of the mean.


There were 13 SIP and 165 NP. There were more male infants (84.6% vs 49.1%, p<0.025) and more out born infants (61.5% vs 39.9%, p<0.05) in the SIP group. The use of maternal tertbutaline was higher in the SIP group (30.8% vs 9.1%, p<0.015). Early treatment with indomethacin (0-3days) was significantly higher in the SIP group (69.2% vs 27.9%, p=0.002). Hypotension requiring dopamine was significantly higher in the SIP group (69.2% vs 34.6%, p=0.017). Combined exposure to antenatal steroids and postnatal indomethacin was significantly higher in the SIP group (69.2% vs 36.4%, p=0.019), as was the combined early treatment with hydrocortisone and indomethacin (7.7% vs 0.6%, p=0.02).


Early use of indomethacin, and co-exposure to antenatal or postnatal steroids is related to development of spontaneous intestinal perforation in extremely low birth weight infants. Prenatal exposure to maternal terbutaline and postnatal use of dopamine for hypotension increases the risk for SIP in these infants.

Keywords: Prematurity, intestinal perforation, risk, indomethacin.